Individual
DR. PHILIP STEPHEN FASTENAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
11100 EUCLID AVE, CLEVELAND, OH 44106-1716
(216) 844-2400
(216) 844-1703
Mailing address
24701 EUCLID AVE, 3RD FLOOR, EUCLID, OH 44117-1714
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
6463
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2842786
—
OH
01
—
P00690297
MEDICARE RAILROAD
OH
Enumeration date
08/05/2008
Last updated
12/08/2020
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