Provider Demographics
NPI:1437555786
Name:SHTULL, KIVA (MD)
Entity Type:Individual
Prefix:
First Name:KIVA
Middle Name:
Last Name:SHTULL
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 1:4450 SAINT CLAIR AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44103-1126
Mailing Address - Country:US
Mailing Address - Phone:216-431-0927
Mailing Address - Fax:
Practice Address - Street 1:7601 FIRST PL STE 7A
Practice Address - Street 2:
Practice Address - City:OAKWOOD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44146-6702
Practice Address - Country:US
Practice Address - Phone:440-799-3741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-14
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH051031207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine