Healthcare Provider Details

I. General information

NPI: 1184589509
Provider Name (Legal Business Name): ELIJAH GEE BLAND
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1794 E 87TH ST
CLEVELAND OH
44106-2023
US

IV. Provider business mailing address

1794 E 87TH ST
CLEVELAND OH
44106-2023
US

V. Phone/Fax

Practice location:
  • Phone: 216-278-6500
  • Fax: 216-278-6500
Mailing address:
  • Phone: 216-278-6500
  • Fax: 216-278-6500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberVP085917
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: