Individual
MARK BOSTELMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11100 EUCLID AVE, CLEVELAND, OH 44106
(216) 844-7330
Mailing address
24701 EUCLID AVE, 3RD FLOOR, EUCLID, OH 44117-1714
(216) 383-6616
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
35065646
OH
207LA0401X
Addiction Medicine (Anesthesiology) Physician
35065646
OH
207LC0200X
Critical Care Medicine (Anesthesiology) Physician
35065646
OH
207LH0002X
Hospice and Palliative Medicine (Anesthesiology) Physician
35065646
OH
207LP2900X
Pain Medicine (Anesthesiology) Physician
35065646
OH
207LP3000X
Pediatric Anesthesiology Physician
35065646
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000225184
UNISON
OH
01
—
000000538739
ANTHEM
OH
05
—
0560905
—
OH
01
—
0583328
BCMH
OH
01
—
414952
WELLCARE MEDICAID
OH
01
—
5656705
AETNA
OH
01
—
751108
BUCKEYE MEDICAID
OH
Enumeration date
04/03/2006
Last updated
08/17/2010
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