Healthcare Provider Details

I. General information

NPI: 1316682586
Provider Name (Legal Business Name): MR. VINEETH POTLURI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2022
Last Update Date: 09/01/2025
Certification Date: 09/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33300 CLEVELAND CLINIC BLVD
AVON OH
44011-1172
US

IV. Provider business mailing address

33300 CLEVELAND CLINIC BLVD FL 3
AVON OH
44011-1172
US

V. Phone/Fax

Practice location:
  • Phone: 440-695-5395
  • Fax:
Mailing address:
  • Phone: 440-695-5395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number35.152278
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: