Basic Information
| Provider Information | |||||||||
| NPI: | 1548294556 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NAKAMOTO | ||||||||
| FirstName: | DEAN | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24701 EUCLID AVE | ||||||||
| Address2: | 3RD FLOOR | ||||||||
| City: | EUCLID | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441171714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2163836950 | ||||||||
| FaxNumber: | 2163836749 | ||||||||
| Practice Location | |||||||||
| Address1: | 11100 EUCLID AVENUE | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2168441700 | ||||||||
| FaxNumber: | 2162866341 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2006 | ||||||||
| LastUpdateDate: | 07/26/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 35055716 | OH | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 35-055716 | OH | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 1012090040001 | 05 | PA | MEDICAID | 732574 | 01 | OH | BUCKEYE | OTHER | 363870 | 01 | OH | WELLCARE | OTHER | 4392730 | 01 | OH | AETNA | OTHER | 0304914 | 01 | OH | BCMH | OTHER | P00364277 | 01 | OH | RAILROAD MEDICARE | OTHER | 000000209122 | 01 | OH | UNISON | OTHER | 000000503572 | 01 | OH | ANTHEM | OTHER | 0882120 | 05 | OH | MEDICAID | 3810009944 | 01 | WV | WV MEDICAID | OTHER |