Healthcare Provider Details

I. General information

NPI: 1093899965
Provider Name (Legal Business Name): JULIERUT TANTIBHEDHYANGKUL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 01/12/2021
Certification Date: 01/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE MAILSTOP-A81
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

9500 EUCLID AVE MAILSTOP-A81
CLEVELAND OH
44195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 216-445-9706
  • Fax:
Mailing address:
  • Phone: 216-444-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number35.091865
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: