Basic Information
| Provider Information | |||||||||
| NPI: | 1831252956 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAMTEW | ||||||||
| FirstName: | BELAI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30701 LORAIN RD STE A | ||||||||
| Address2: | |||||||||
| City: | NORTH OLMSTED | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440706325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4402745000 | ||||||||
| FaxNumber: | 4407168608 | ||||||||
| Practice Location | |||||||||
| Address1: | 7255 OLD OAK BLVD | ||||||||
| Address2: | BLDG C, SUITE 302 | ||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441303329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4408164394 | ||||||||
| FaxNumber: | 4408166755 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2006 | ||||||||
| LastUpdateDate: | 11/01/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | 35-052033 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
ID Information
| ID | Type | State | Issuer | Description | 000000113874 | 01 | OH | ANTHEM | OTHER | 1305865 | 01 | OH | UNITED HEALTHCARE | OTHER | 69548 | 01 | OH | QUALCHOICE | OTHER | 3810003607 | 05 | WV | MEDICAID | 0666766 | 05 | OH | MEDICAID |