Provider Demographics
NPI:1417907155
Name:OHIO CARDIOTHORACIC & VASUCLAR SURGEONS INC
Entity Type:Organization
Organization Name:OHIO CARDIOTHORACIC & VASUCLAR SURGEONS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FARZIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FOTOUHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-227-7702
Mailing Address - Street 1:951 COMMERCE PKWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45804-4040
Mailing Address - Country:US
Mailing Address - Phone:419-227-7702
Mailing Address - Fax:419-227-7991
Practice Address - Street 1:951 COMMERCE PKWY
Practice Address - Street 2:SUITE 201
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804-4040
Practice Address - Country:US
Practice Address - Phone:419-227-7702
Practice Address - Fax:419-227-7991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2252388Medicaid
OH4513328OtherAETNA
OH4513328OtherAETNA