Provider Demographics
NPI:1790770568
Name:NATESAN, CORATTUR NATESA (MD)
Entity Type:Individual
Prefix:DR
First Name:CORATTUR
Middle Name:NATESA
Last Name:NATESAN
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 1:464 RICHMOND RD STE 102
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-2704
Mailing Address - Country:US
Mailing Address - Phone:216-486-3233
Mailing Address - Fax:216-486-3180
Practice Address - Street 1:11201 SHAKER BLVD
Practice Address - Street 2:SUITE 240
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44104-3873
Practice Address - Country:US
Practice Address - Phone:216-791-0017
Practice Address - Fax:216-791-0021
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35083481207RA0401X
OH35083481N207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2507997Medicaid
OHI21172Medicare UPIN
OH4146591Medicare ID - Type Unspecified