Doctor Name: | JAMES CHARLES GAIDELIS |
NPI Number: | 1154377976 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PA-C, R.N. |
License Number: | |
Business Practice Address: | 13241 Ravenna Rd Chardon, OH - 440249012 |
Business Phone Number: | 2163830100 |
Business Fax Number: | 2163836481 |
Mailing Address: | Po Box 74751, CLEVELAND |
State: | OH |
Postal Code: | 441940834 |
Phone Number: | 2163836480 |
Fax Number: | 2163836745 |
NPI Enumeration Date: | 05/25/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AS0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Surgical |
Taxonomy Definition: |