Provider Demographics
NPI:1376934935
Name:COSMOPOLITAN DERMATOLOGY, INC.
Entity Type:Organization
Organization Name:COSMOPOLITAN DERMATOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:O
Authorized Official - Last Name:KYEI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-417-3250
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44286-0188
Mailing Address - Country:US
Mailing Address - Phone:216-417-3250
Mailing Address - Fax:216-417-3251
Practice Address - Street 1:3461 WARRENSVILLE CENTER RD STE 100
Practice Address - Street 2:
Practice Address - City:SHAKER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44122-5227
Practice Address - Country:US
Practice Address - Phone:216-417-3250
Practice Address - Fax:216-417-3251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-17
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0118772Medicaid
OH0118772Medicaid