Provider Demographics
NPI:1396994463
Name:KAINE, PATRICIA A
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:A
Last Name:KAINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4432 PEARL RD
Mailing Address - Street 2:SUITE #201
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-4225
Mailing Address - Country:US
Mailing Address - Phone:216-789-7236
Mailing Address - Fax:440-888-0523
Practice Address - Street 1:4432 PEARL RD
Practice Address - Street 2:SUITE #201
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-4225
Practice Address - Country:US
Practice Address - Phone:216-789-7236
Practice Address - Fax:440-888-0523
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-15
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-050134207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0557160Medicaid
OH0557160Medicaid