Provider Demographics
NPI:1215958954
Name:TOLTZIS, PHILIP H (MD)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:H
Last Name:TOLTZIS
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 1:3605 WARRENSVILLE CENTER RD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5203
Mailing Address - Country:US
Mailing Address - Phone:216-286-6299
Mailing Address - Fax:216-286-6341
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-7700
Practice Address - Fax:216-286-6341
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0576572080P0203X
OH35-057675207L00000X, 2080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011932330003Medicaid
OH364081OtherWELLCARE
OHP00618517OtherRAILROAD MEDICARE
OH719191OtherBCMH
OH000000028077OtherANTHEM
OH000000221099OtherUNISON
OH647837OtherAETNA
OH733410OtherBUCKEYE
OH0719191Medicaid
OH370001965OtherRAILROAD MEDICARE
PA1011932330003OtherPA MEDICAID
OH000000526180OtherANTHEM
OH364081OtherWELLCARE
OH647837OtherAETNA
OHD88439Medicare UPIN