Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 30-021592 | OH |
Y | 213EG0000X | General Practice | 30-021592 | OH |
NPI | 1003834763 |
---|---|
Provider Name | Shelly K Haas |
First Address | Cleveland, OH 44315 |
Second Address | Cleveland, OH 44135 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 14/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2372132 | (05) | OH |