Provider Demographics
NPI:1083640775
Name:PLATT HOUSTON, CANDIS N (MD)
Entity Type:Individual
Prefix:
First Name:CANDIS
Middle Name:N
Last Name:PLATT HOUSTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 METROHEALTH DR
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-1900
Mailing Address - Country:US
Mailing Address - Phone:216-778-7800
Mailing Address - Fax:
Practice Address - Street 1:2500 METROHEALTH DR
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-1900
Practice Address - Country:US
Practice Address - Phone:216-778-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35082904208000000X
OH35-082904208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2408675Medicaid
OH000000221236OtherUNISON
OH000000526141OtherANTHEM
OH363917OtherWELLCARE
PA1018900270001Medicaid
OH740613OtherBUCKEYE
OH7978468OtherAETNA
OH2408675OtherBCMH
PA1018900270001Medicaid
OH363917OtherWELLCARE
OH2408675Medicaid