Provider Demographics
NPI:1043779911
Name:CORTESE, GREGORY B (NP-C)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:B
Last Name:CORTESE
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1466 ORCHARD GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-3726
Mailing Address - Country:US
Mailing Address - Phone:216-990-8334
Mailing Address - Fax:
Practice Address - Street 1:32800 LORAIN RD
Practice Address - Street 2:
Practice Address - City:NORTH RIDGEVILLE
Practice Address - State:OH
Practice Address - Zip Code:44039-3430
Practice Address - Country:US
Practice Address - Phone:866-844-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.024428207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology