Provider Demographics
NPI:1235156092
Name:LIDSKY, KAREN B (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:B
Last Name:LIDSKY
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 1:9500 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:216-444-3322
Mailing Address - Fax:
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-8202
Practice Address - Country:US
Practice Address - Phone:164-443-3222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-070761207L00000X, 2080P0204X, 2080P0214X, 2080P0203X
FLME130140208000000X, 2080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
No2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1011172800001OtherPA MEDICAID
OH000000526044OtherANTHEM
FL019488700Medicaid
OH263790OtherBCMH
OH363768OtherWELLCARE
MI1235156092OtherMI MEDICAID
OH000000027350OtherANTHEM
OH733818OtherBUCKEYE
OHP00618510OtherRAILROAD MEDICARE
OH0263790Medicaid
OH2134098OtherAETNA
OH000000221189OtherUNISON
NY02558625OtherNY MEDICAID
OHG44755Medicare UPIN
OH000000221189OtherUNISON
OH0263790Medicaid