Healthcare Provider Details

I. General information

NPI: 1558464883
Provider Name (Legal Business Name): SUDHIR R OZA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 08/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16111 LORAIN AVE
CLEVELAND OH
44111-5520
US

IV. Provider business mailing address

16111 LORRAIN AVENUE
CLEVELAND OH
44145
US

V. Phone/Fax

Practice location:
  • Phone: 216-252-8444
  • Fax: 216-252-7224
Mailing address:
  • Phone: 216-252-8444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35045653
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number35045653
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35045653
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: