Healthcare Provider Details

I. General information

NPI: 1578557179
Provider Name (Legal Business Name): JACQUELINE TAMIS-HOLLAND M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 03/07/2023
Certification Date: 03/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVENUE J-209
CLEVELAND OH
44195
US

IV. Provider business mailing address

9500 EUCLID AVENUE J-209
CLEVELAND OH
44195
US

V. Phone/Fax

Practice location:
  • Phone: 216-444-2829
  • Fax:
Mailing address:
  • Phone: 216-444-2829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number186575
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number35.147213
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: