Provider Demographics
NPI:1386345338
Name:CLEVELAND OBGYN LLC
Entity type:Organization
Organization Name:CLEVELAND OBGYN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHATA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:647-705-1655
Mailing Address - Street 1:1028 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:OH
Mailing Address - Zip Code:44041-7124
Mailing Address - Country:US
Mailing Address - Phone:647-705-1655
Mailing Address - Fax:
Practice Address - Street 1:1028 S BROADWAY
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:OH
Practice Address - Zip Code:44041-7124
Practice Address - Country:US
Practice Address - Phone:647-705-1655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-16
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty