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
18099 LORAIN AVE, SUITE 312, CLEVELAND, OH 44111-5610
(216) 941-0066
(216) 941-3667
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
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0251856
—
OH
Enumeration date
09/27/2010
Last updated
09/27/2010
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