Organization
LAKE COUNTY AND WEST EKG ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. M AHMAD BANNA MD (PRESIDENT)
(440) 358-5555
Entity
Organization
Contact information
Practice address
7500 AUBURN RD, SUITE 200, PAINESVILLE, OH 44077-9602
(440) 352-2754
(440) 352-0330
Mailing address
30701 LORAIN RD STE A, NORTH OLMSTED, OH 44070-6325
(440) 274-5000
(440) 716-8608
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0813794
—
OH
01
—
18958
QUALCHOICE
OH
01
—
2597481
UNITED HEALTHCARE
OH
01
—
264168
FEDERAL BLACK LUNG
OH
01
—
CK1332
RAILROAD MEDICARE B
OH
Enumeration date
03/20/2006
Last updated
09/18/2014
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