Organization
OUTREACH PROFESSIONAL SERVICES INC
Active
Other names
Cuyahoga Physician Network
Organization subpart
No
Provider details
NPI number
Authorized official
MISTY A BLAYLOCK (CREDENTIALING COORDINATOR)
(440) 892-6406
Entity
Organization
Contact information
Practice address
33141 BAINBRIDGE RD, SOLON, OH 44139
(440) 248-8888
(440) 349-4026
Mailing address
26908 DETROIT RD, SUITE 301, WESTLAKE, OH 44145-2398
(440) 617-1823
(440) 617-0884
Taxonomy
Speciality
Code
Description
License number
State
207RS0010X
Sports Medicine (Internal Medicine) Physician
Primary
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
213E00000X
Podiatrist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0251856
—
OH
Enumeration date
12/05/2007
Last updated
01/12/2010
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