MEDICARE: DR. EDGARD ANDRE BENDALY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080P0202X	Pediatric Cardiology Physician	40907	IA
2	2080P0202X	Pediatric Cardiology Physician	8561	SD
3	2080P0202X	Pediatric Cardiology Physician	35.137251	OH

General Provider Information

NPI Number	:	1225247406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDGARD ANDRE BENDALY MD

Provider Business Mailing Address
First Line	:	9500 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44195-5074
Country	:	US
Telephone Number	:	216-636-1166
Fax Number	:

Provider Business Practice Location Address
First Line	:	9500 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44195-5074
Country	:	US
Telephone Number	:	216-636-1166
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	05/30/2023

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