Provider Demographics
NPI:1518188879
Name:DORNAN, KURTIS CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:KURTIS
Middle Name:CHARLES
Last Name:DORNAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:37855 ELVA LN
Mailing Address - Street 2:
Mailing Address - City:NORTH RIDGEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44039-8719
Mailing Address - Country:US
Mailing Address - Phone:330-473-2201
Mailing Address - Fax:
Practice Address - Street 1:19800 DETROIT RD STE 100
Practice Address - Street 2:
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-1885
Practice Address - Country:US
Practice Address - Phone:216-608-8000
Practice Address - Fax:216-608-8001
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.088772207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine