Healthcare Provider Details

I. General information

NPI: 1184428336
Provider Name (Legal Business Name): THE CLEVELAND CLINIC FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2025
Last Update Date: 08/12/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36040 DETROIT RD STE A
AVON OH
44011-1686
US

IV. Provider business mailing address

6801 BRECKSVILLE RD STE 20 ATTN: DPC RK2-7
INDEPENDENCE OH
44131
US

V. Phone/Fax

Practice location:
  • Phone: 886-636-3318
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DENNIS LARAWAY
Title or Position: EXECUTIVE VP CHIEF FINANCE OFFICER
Credential:
Phone: 216-445-1343