Provider Demographics
NPI:1407845902
Name:REISMAN, JON (MD)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:
Last Name:REISMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:26908 DETROIT RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-2398
Mailing Address - Country:US
Mailing Address - Phone:440-617-1823
Mailing Address - Fax:440-617-0884
Practice Address - Street 1:2322 E 22ND ST
Practice Address - Street 2:SUITE 200
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-3176
Practice Address - Country:US
Practice Address - Phone:216-363-3309
Practice Address - Fax:216-363-2768
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2009-03-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35048202207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0511628Medicaid
OH900003186OtherRR MEDICARE
OH900003186OtherRR MEDICARE
OH0578655Medicare PIN