Healthcare Provider Details

I. General information

NPI: 1376538363
Provider Name (Legal Business Name): FAITH MEDICAL ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 11/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11201 SHAKER BLVD 240
CLEVELAND OH
44104-3869
US

IV. Provider business mailing address

11201 SHAKER BLVD 240
CLEVELAND OH
44104-3869
US

V. Phone/Fax

Practice location:
  • Phone: 216-791-0017
  • Fax: 216-791-0021
Mailing address:
  • Phone: 216-791-0017
  • Fax: 216-791-0021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35061601
License Number StateOH

VIII. Authorized Official

Name: DR. JILL M BARRY
Title or Position: VICE PRESIDENT
Credential: M.D.
Phone: 216-791-0017