Provider Demographics
NPI:1114949484
Name:CHO, KATHLEEN Y (MD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:Y
Last Name:CHO
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 1:3605 WARRENSVILLE CENTER RD
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:SHAKER HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5203
Mailing Address - Country:US
Mailing Address - Phone:216-286-6260
Mailing Address - Fax:216-286-6341
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-7330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-084351207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000516024OtherANTHEM
OH2501082Medicaid
OHP00398014OtherRAILROAD MEDICARE
OH7508591OtherAETNA
OH000000221145OtherUNISON
OH0583328OtherBCMH
OH363422OtherWELLCARE MEDICAID
OH746595OtherBUCKEYE MEDICAID
OHP00200212OtherRAILROAD MEDICARE
E36148Medicare UPIN
OH2501082Medicaid
OHCH4140472Medicare PIN