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NPI Code Detail

MEDICARE: UNIVERSITY HOSPITALS MEDICAL GROUP, INC.

MEDICARE: UNIVERSITY HOSPITALS MEDICAL GROUP, INC.
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
12086S0129XVascular Surgery PhysicianOH
22085R0202XDiagnostic Radiology PhysicianOH
3207RC0000XCardiovascular Disease PhysicianOH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1659606515
Entity Type Code : Organization
Provider Name (Legal Business Name) : UNIVERSITY HOSPITALS MEDICAL GROUP, INC.
Provider Business Mailing Address
First Line : 24701 EUCLID AVE
Second Line : 3RD FLOOR
City : EUCLID
State : OH
Zip : 44117-1714
Country : US
Telephone Number : 216-383-6616
Fax Number :
Provider Business Practice Location Address
First Line : 158 W MAIN RD
Second Line :
City : CONNEAUT
State : OH
Zip : 44030-2039
Country : US
Telephone Number : 440-593-0257
Fax Number :
Authorized Official
Title or Position : VICE PRESIDENT OF FINANCE
Name : LARRY MCELROY
Credential :
Telephone Number : 216-767-8717
Provider Enumeration Date : 10/12/2009
Last Update Date : 10/25/2010

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