Provider Demographics
NPI:1831184993
Name:HUNTLEY, HOMER N (MD)
Entity type:Individual
Prefix:DR
First Name:HOMER
Middle Name:N
Last Name:HUNTLEY
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 1:10515 CARNEGIE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-3016
Mailing Address - Country:US
Mailing Address - Phone:216-928-0136
Mailing Address - Fax:216-928-0141
Practice Address - Street 1:10515 CARNEGIE AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-3016
Practice Address - Country:US
Practice Address - Phone:216-928-0136
Practice Address - Fax:216-928-0141
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-06-1010207LP2900X
FLME163411207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0821301Medicaid
OH4066562Medicare ID - Type Unspecified
OH0821301Medicaid