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
2322 EAST 22ND ST, SUITE 207, CLEVELAND, PA 44145
(216) 592-2801
(216) 592-2811
Mailing address
26908 DETROIT RD, SUITE 301, WESTLAKE, OH 44145-2398
(440) 617-1823
(440) 617-0884
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0251856
—
OH
Enumeration date
12/04/2007
Last updated
01/12/2010
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