Healthcare Provider Details

I. General information

NPI: 1659364891
Provider Name (Legal Business Name): JEREMY C HOBAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 05/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 EUCLID AVE
CLEVELAND OH
44106-5293
US

IV. Provider business mailing address

3605 WARRENSVILLE CENTER ROAD 1ST FLOOR
SHAKER HTS OH
44122
US

V. Phone/Fax

Practice location:
  • Phone: 216-844-7330
  • Fax:
Mailing address:
  • Phone: 440-891-8800
  • Fax: 440-891-1734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35-082812
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number35-082812
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: