Provider Demographics
NPI:1538772611
Name:HILASZEK, ROSS (OCPRS)
Entity type:Individual
Prefix:
First Name:ROSS
Middle Name:
Last Name:HILASZEK
Suffix:
Gender:M
Credentials:OCPRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 WILLOWDALE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-2838
Mailing Address - Country:US
Mailing Address - Phone:216-415-2841
Mailing Address - Fax:
Practice Address - Street 1:2001 WILLOWDALE AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-2838
Practice Address - Country:US
Practice Address - Phone:216-415-2841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0001967175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist