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Organization

EASTSIDE PRIMARY CARE LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JEAN B LENK MD (OWNER)
(440) 946-4070
Entity
Organization

Contact information

Practice address
36100 EUCLID AVE, #430, WILLOUGHBY, OH 44094-4456
(440) 946-4070
(440) 946-4071
Mailing address
PO BOX 22958, CLEVELAND, OH 44122-0958
(216) 595-9600
(216) 595-9601

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0819663
OH
Enumeration date
10/27/2010
Last updated
05/09/2012
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