Provider Demographics
NPI:1053584193
Name:AMADO DE OLAZAVAL, ANTOINE (MD)
Entity type:Individual
Prefix:
First Name:ANTOINE
Middle Name:
Last Name:AMADO DE OLAZAVAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 EUCLID AVE
Mailing Address - Street 2:DESK A61
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:216-445-3643
Mailing Address - Fax:216-636-5151
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:DESK A61
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-445-3643
Practice Address - Fax:216-636-5151
Is Sole Proprietor?:No
Enumeration Date:2008-04-09
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35099281207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology