Provider Demographics
NPI:1891115788
Name:BATTISTI, SEAN KENNETH (MD)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:KENNETH
Last Name:BATTISTI
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 1:14401 SNOW RD STE 106
Mailing Address - Street 2:
Mailing Address - City:BROOKPARK
Mailing Address - State:OH
Mailing Address - Zip Code:44142-2583
Mailing Address - Country:US
Mailing Address - Phone:216-898-2229
Mailing Address - Fax:216-898-2217
Practice Address - Street 1:14401 SNOW RD STE 106
Practice Address - Street 2:
Practice Address - City:BROOKPARK
Practice Address - State:OH
Practice Address - Zip Code:44142-2583
Practice Address - Country:US
Practice Address - Phone:216-898-2229
Practice Address - Fax:216-898-2217
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-18
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.130213207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0267583Medicaid