Individual
OTIS MARK HASTINGS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
14519 DETROIT AVE, LAKEWOOD, OH 44107-4316
(216) 521-4200
Mailing address
28625 WOODMILL DR, WESTLAKE, OH 44145-2085
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
35059241H
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000380930
ANTHEM BC/BS
OH
05
—
0798329
—
OH
01
—
341542312098
CARESOURCE
OH
01
—
378646
WELLCARE
OH
01
—
930007405
MEDICARE TRAVELERS RR-GA
OH
01
—
942460636261
CARESOURCE
OH
Enumeration date
05/28/2006
Last updated
05/02/2008
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