Healthcare Provider Details

I. General information

NPI: 1548503592
Provider Name (Legal Business Name): MS. JESSICA MAYUMI LUM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2013
Last Update Date: 05/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

INFECTIOUS DISEASE G21 9500 EUCLID AVENUE
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

INFECTIOUS DISEASE G21 9500 EUCLID AVENUE
CLEVELAND OH
44195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 216-444-8845
  • Fax: 216-445-9446
Mailing address:
  • Phone: 216-444-8845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125063477
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberTL0006307
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number35.136151
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: