Organization
CENTER FOR VASCULAR AND THORACIC MEDICINE AND SURGERY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JUDY KLEKOTA CPCS (CREDENTIALING COORDINATOR)
(440) 233-1003
Entity
Organization
Contact information
Practice address
2173 N RIDGE RD E, SUITE A, LORAIN, OH 44055-3400
(440) 277-5077
(440) 277-6696
Mailing address
2173 N RIDGE RD E, SUITE A, LORAIN, OH 44055-3400
(440) 277-5077
(440) 277-6696
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
35053879
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0636306
—
OH
Enumeration date
09/26/2006
Last updated
11/02/2007
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