Provider Demographics
NPI:1790842656
Name:GRADY, KATHLEEN T (MD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:T
Last Name:GRADY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:T
Other - Last Name:DOYLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:24701 EUCLID AVE
Mailing Address - Street 2:THIRD FLOOR BILLING SERVICES
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:440-808-9228
Mailing Address - Fax:440-808-9234
Practice Address - Street 1:960 CLAGUE RD
Practice Address - Street 2:SUITE 1850
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-1582
Practice Address - Country:US
Practice Address - Phone:440-808-9228
Practice Address - Fax:440-808-9234
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036113546208000000X
OH35.121961208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0091990Medicaid