Provider Demographics
NPI:1134152309
Name:ACHESON, LOUISE S (MD)
Entity type:Individual
Prefix:
First Name:LOUISE
Middle Name:S
Last Name:ACHESON
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 1:24701 EUCLID AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-3944
Practice Address - Fax:216-286-6341
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50825207Q00000X
OH35-050825207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH633304OtherAETNA
OH000000135261OtherANTHEM
000000224222OtherUNISON
OH000000530380OtherANTHEM
OH0564269Medicaid
OH80044866OtherRAILROAD MEDICARE
363296OtherWELLCARE
767669OtherBUCKEYE
000000224222OtherUNISON
OH633304OtherAETNA
OH80044866OtherRAILROAD MEDICARE