Individual
EILEEN K STORK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
11100 EUCLID AVE, CLEVELAND, OH 44106-1716
(216) 844-7700
(216) 286-6341
Mailing address
24701 EUCLID AVE, 3RD FLOOR, EUCLID, OH 44117-1714
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
35-046538
OH
207LP3000X
Pediatric Anesthesiology Physician
35-046538
OH
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
35-046538
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000028079
ANTHEM
OH
01
—
000000221108
UNISON
OH
01
—
000000526134
ANTHEM
OH
05
—
0558123
—
OH
01
—
364050
WELLCARE
OH
01
—
558123
BCMH
OH
01
—
640222
AETNA
OH
01
—
732886
BUCKEYE
OH
Enumeration date
07/18/2006
Last updated
07/06/2011
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