Provider Demographics
NPI:1194764803
Name:HILDE, JOHN (PA)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:HILDE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CLEVELAND CLINIC-FAIRVIEW HOSPITAL, 18101 LORAIN AVENUE
Mailing Address - Street 2:EMERGENCY SERVICES
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-5612
Mailing Address - Country:US
Mailing Address - Phone:216-476-7312
Mailing Address - Fax:
Practice Address - Street 1:CLEVELAND CLINIC-FAIRVIEW HOSPITAL, 18101 LORAIN AVENUE
Practice Address - Street 2:EMERGENCY SERVICES
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-5612
Practice Address - Country:US
Practice Address - Phone:216-476-7312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50001766363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant