Individual
KEITH L PONITZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11100 EUCLID AVE, CLEVELAND, OH 44106-1716
(216) 844-7700
Mailing address
24701 EUCLID AVE, 3RD FLOOR, EUCLID, OH 44117-1714
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
35-065293
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000028325
ANTHEM
OH
01
—
000000221405
UNISON
OH
01
—
000000526090
ANTHEM
OH
05
—
0929599
—
OH
05
—
1011566260001
—
PA
01
—
200206600A
OK MEDICAID
OK
01
—
645544
AETNA
OH
01
—
929599
BCMH
OH
Enumeration date
08/31/2006
Last updated
07/18/2013
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