Provider Demographics
NPI:1578763330
Name:GULLING-LEFTWICH, TRACY LYNN (DO)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:LYNN
Last Name:GULLING-LEFTWICH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:LYNN
Other - Last Name:GULLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:9500 EUCLID AVE # CA53
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:216-445-0132
Mailing Address - Fax:216-636-3179
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:M2-ANNEX
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-444-0933
Practice Address - Fax:216-445-8530
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.011315207RH0002X, 208M00000X, 207R00000X
CT048593207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTPENDINGMedicaid
CTPENDINGMedicaid
CTPENDING - C00023Medicare PIN