Healthcare Provider Details

I. General information

NPI: 1639139181
Provider Name (Legal Business Name): JOHN V CUA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 11/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9937 SHADY LN
BROOKLYN OH
44144-3010
US

IV. Provider business mailing address

26908 DETROIT RD SUITE 301
WESTLAKE OH
44145-2398
US

V. Phone/Fax

Practice location:
  • Phone: 216-741-3627
  • Fax:
Mailing address:
  • Phone: 440-892-6406
  • Fax: 440-617-0884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.034096
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: