CLARK W DISTELHORST (NPI# 1669491411) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669491411 |
| Entity Type | Individual |
| Full Name | CLARK W DISTELHORST |
| Credential | MD |
| Practice Address |
11100 Euclid Ave Cleveland OH 44106-1716 |
| Mailing Address |
24701 Euclid Ave 3rd Floor Euclid OH 44117-1714 |
| Practice Telephone | 2168448500 |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2011-10-18 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RH0003X |
Internal Medicine Specialization: Hematology & Oncology |
35-033648 | OH | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ANTHEM | 000000539544 | 01 | |
| WELLCARE | 363485 | 01 | |
| OH | RAILROAD MEDICARE | 700006761 | 01 |
| BUCKEYE | 741817 | 01 | |
| OH | AETNA | 0639627 | 01 |
| OH | 0600728 | 05 | |
| UNISON | 000000224261 | 01 |
| Street Address |
11100 EUCLID AVE |
| City | CLEVELAND |
| State | OH |
| Zip Code | 44106-1716 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801899927 | Joel H. Elconin | Radiology | 11100 Euclid Ave, Ireland/seidman Radiation Oncology, Cleveland, OH 44106 | 2005-05-23 |
| 1386245207 | Dalal Hamad A Alsaggabi | Student in an Organized Health Care Education/Training Program | 11100 Euclid Ave, Cleveland, OH 44106-1716 | 2020-11-06 |
| 1922609809 | Melanie Wolf | Registered Nurse | 11100 Euclid Ave, Cleveland, OH 44106-1716 | 2020-11-05 |
| 1093313918 | Aryn Rose Pecoraro | Nurse Practitioner | 11100 Euclid Ave, Cleveland, OH 44106-1716 | 2020-10-13 |
| 1366058331 | Harun Abukar | Registered Nurse | 11100 Euclid Ave, Cleveland, OH 44106-1716 | 2020-09-16 |
| 1205442290 | Jessica Regan | Dietitian, Registered | 11100 Euclid Ave, Cleveland, OH 44106-1716 | 2020-09-16 |
| 1740895960 | Sara Lyn Stefano | Nurse Practitioner | 11100 Euclid Ave, Cleveland, OH 44106-1716 | 2020-09-14 |
| 1063026052 | Meredith Barker | Nurse Practitioner | 11100 Euclid Ave, Cleveland, OH 44106-1716 | 2020-09-07 |
| 1124631114 | Luis Augusto Palma Dallan | Student in an Organized Health Care Education/Training Program | 11100 Euclid Ave, Cleveland, OH 44106-1716 | 2020-08-28 |
| 1023621216 | Stephanie Casto | Nurse Practitioner | 11100 Euclid Ave, Cleveland, OH 44106-1716 | 2020-08-26 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295347706 | Adeeb Oweidat | Anesthesiology | 1999 Circle Drive Centric, Apartment 417, Cleveland, OH 44106 | 2020-08-18 |
| 1104434240 | Bradly Miner | Student in an Organized Health Care Education/Training Program | Health Education Campus, 9501 Euclid Ave, Cleveland, OH 44106 | 2020-07-15 |
| 1306466974 | Ho Jun Lee | Student in an Organized Health Care Education/Training Program | 11100 Euclid Ave University Hospitals Cleveland Medical, Cleveland, OH 44106 | 2020-04-23 |
| 1528687837 | Shaleeka Cornelius | Student in an Organized Health Care Education/Training Program | 11100 Euclid Avenue Han 5042, University Hospitals Cleveland Medical Center, Cleveland, OH 44106 | 2020-04-16 |
| 1598393175 | Mikdat Ulas | Student in an Organized Health Care Education/Training Program | 111000 Euclid Avenue, Cleveland, OH 44106 | 2020-03-30 |
| 1790335651 | Michelle Clark | Home Health Aide | 1794 E 87th St, Cleveland, OH 44106 | 2019-09-12 |
| 1881246783 | Oziel Valdez Sanchez | Student in an Organized Health Care Education/Training Program | 11900 Euclid Ave, Cleveland, OH 44106 | 2019-07-10 |
| 1487216842 | Betina Griens Porto | Dentist | 9601 Chester Avenue, Case Western Reserve School of Dental Medicine, Cleveland, OH 44106 | 2019-07-05 |
| 1407417140 | Rebecca Petts | Dentist | 9601 Chester Ave, Cleveland, OH 44106 | 2019-06-24 |
| 1023677259 | Moeen Al Weshah | Student in an Organized Health Care Education/Training Program | 9601 Chester Ave # 239j3, Cleveland, OH 44106 | 2019-06-11 |
| Find all providers in zip 44106 | ||||
| Taxonomy Code | 207RH0003X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Hematology & Oncology |
| An internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2007. [7/1/2008: definiton added, source added; 7/1/2011: modified source] - Additional Resources: http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942572862 | Tennessee Cancer Specialists, Pllc | Internal Medicine | 2305 Chambliss Ave, Sw, Sky Ridge Medical Center Main, Cleveland, TN 37311-3899 | 2012-02-08 |
| 1629211982 | David James Seastone | Internal Medicine | Ccf Deparment of Hematology Oncology, 9500 Euclid Ave, Cleveland, OH 44195-0001 | 2009-04-15 |
| 1922254937 | Aaron T Gerds | Internal Medicine | 9500 Euclid Ave R35, Cleveland, OH 44195 | 2008-08-09 |
| 1366637563 | An L Tran | Internal Medicine | 2390 N. Ocoee St., Cleveland, TN 37311 | 2007-09-11 |
| 1962510826 | Alberto Jose Montero | Internal Medicine | Taussig Cancer Institute 9500 Euclid Ave, R35, Cleveland, OH 44195-1002 | 2006-08-29 |
| 1942206388 | Paul F Hergenroeder | Internal Medicine | 17876 Saint Clair Ave, Cleveland, OH 44110 | 2005-06-21 |
| 1588669113 | Donald Eicher | Internal Medicine | 18200 Lorain Ave, Moll Pavilion, Cleveland, OH 44111-5605 | 2005-06-20 |
| 1437152691 | Sylvia L Krueger | Internal Medicine | 2390 N Ocoee St, Cleveland, TN 37311-3850 | 2005-05-23 |
| 1033764600 | Heather R Skomski | Internal Medicine | 11100 Euclid Ave, Cleveland, OH 44106-1716 | 2019-08-09 |
| 1902269137 | Amanda Nizam | Internal Medicine | 9500 Euclid Ave, Cleveland, OH 44195-3201 | 2016-04-04 |
| Find all providers in CLEVELAND | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.