Provider Demographics
NPI:1710069562
Name:JOHN OTOOLE MD INC
Entity Type:Organization
Organization Name:JOHN OTOOLE MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:OTOOLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-892-3412
Mailing Address - Street 1:1751 FARRS GARDEN PATH
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145
Mailing Address - Country:US
Mailing Address - Phone:440-892-3412
Mailing Address - Fax:
Practice Address - Street 1:3600 KOLBE RD
Practice Address - Street 2:#202
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053
Practice Address - Country:US
Practice Address - Phone:216-443-0430
Practice Address - Fax:216-443-0435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35066945207P00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
9347111Medicare ID - Type Unspecified