Provider Demographics
NPI:1972563997
Name:KEZELE, GREGORY PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:PAUL
Last Name:KEZELE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3737 PARK EAST DR STE 109
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4329
Mailing Address - Country:US
Mailing Address - Phone:216-464-7333
Mailing Address - Fax:216-342-5462
Practice Address - Street 1:3737 PARK EAST DR STE 109
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4329
Practice Address - Country:US
Practice Address - Phone:216-464-7333
Practice Address - Fax:216-464-2696
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2023-10-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35-057308207Q00000X
OH35057308202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000339410OtherANTHEM
OH2255705Medicaid
OH80507OtherQUALCHOICE
OH9379701OtherGROUP MEDICARE PTAN
OHDO6570OtherGROUP MEDICARE RAILROAD PTAN
OH264200000OtherDEPT OF LABOR
OHH152671OtherMEDICARE INDIVIDUAL PTAN
OHP01371818OtherMEDICARE RAILROAD INDIVIDUAL PTAN
OH264200000OtherFEDERAL BLACK LUNG
OH341425870042OtherMEDICAL MUTUAL OF OHIO
OH6600162OtherRAILROAD
OH264200000OtherFEDERAL BLACK LUNG