Provider Demographics
NPI:1912600552
Name:LENTUOR, IMAHD
Entity Type:Individual
Prefix:
First Name:IMAHD
Middle Name:
Last Name:LENTUOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15713 MAPLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44137-3930
Mailing Address - Country:US
Mailing Address - Phone:216-868-6655
Mailing Address - Fax:
Practice Address - Street 1:15713 MAPLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:MAPLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44137-3930
Practice Address - Country:US
Practice Address - Phone:216-868-6655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver