Healthcare Provider Details

I. General information

NPI: 1558335406
Provider Name (Legal Business Name): KENNETH R MCCURRY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 04/13/2022
Certification Date: 04/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE # J4-1
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

9500 EUCLID AVE # J4-1
CLEVELAND OH
44195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 216-445-9303
  • Fax:
Mailing address:
  • Phone: 216-445-9303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD063784L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number35.092673
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: