Provider Demographics
NPI:1578503272
Name:KONTAK, JAMES A (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:A
Last Name:KONTAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:18099 LORAIN AVE
Mailing Address - Street 2:SUITE 141
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-5610
Mailing Address - Country:US
Mailing Address - Phone:216-941-0333
Mailing Address - Fax:216-941-5257
Practice Address - Street 1:18099 LORAIN AVE
Practice Address - Street 2:SUITE 141
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-5610
Practice Address - Country:US
Practice Address - Phone:216-941-0333
Practice Address - Fax:216-941-1071
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35-086555208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHUR9354701OtherMEDICARE GROUP PIN #
OH2580103Medicaid
OHUR9354701OtherMEDICARE GROUP PIN #
OHI32961Medicare UPIN