Provider Demographics
NPI:1235179862
Name:LASHUTKA, MATTHEW K (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:K
Last Name:LASHUTKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18101 LORAIN AVENUE, CLEVELAND CLINIC-FAIRVIEW HOSPITAL
Mailing Address - Street 2:EMERGENCY SERVICES
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-5612
Mailing Address - Country:US
Mailing Address - Phone:216-476-7312
Mailing Address - Fax:
Practice Address - Street 1:18101 LORAIN AVENUE, CLEVELAND CLINIC-FAIRVIEW HOSPITAL
Practice Address - Street 2:EMERGENCY SERVICES
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-5612
Practice Address - Country:US
Practice Address - Phone:216-476-7312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35078592L207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH942460636119OtherCARESOURCE
OH2325979Medicaid
OHP00194538OtherMEDICARE RR-GA
OH942460636119OtherCARESOURCE
OHH57844Medicare UPIN