Provider Demographics
NPI:1184237968
Name:GREATER CLEVELAND PEDIATRICS
Entity type:Organization
Organization Name:GREATER CLEVELAND PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEILI
Authorized Official - Middle Name:
Authorized Official - Last Name:MISTOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-562-3772
Mailing Address - Street 1:2956 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-2450
Mailing Address - Country:US
Mailing Address - Phone:614-562-3772
Mailing Address - Fax:
Practice Address - Street 1:3311 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4195
Practice Address - Country:US
Practice Address - Phone:614-562-3772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty