Healthcare Provider Details

I. General information

NPI: 1649386350
Provider Name (Legal Business Name): DR. RINKU X MUKHERJEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 08/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 EUCLID AVE HANNA HOUSE
CLEVELAND OH
44106-1716
US

IV. Provider business mailing address

24701 EUCLID AVE
EUCLID OH
44117-1714
US

V. Phone/Fax

Practice location:
  • Phone: 216-844-1262
  • Fax:
Mailing address:
  • Phone: 216-844-1262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0061343
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number35-095666
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: