Healthcare Provider Details

I. General information

NPI: 1437103389
Provider Name (Legal Business Name): SHREE K KURUP M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 01/11/2021
Certification Date: 01/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 EUCLID AVE
CLEVELAND OH
44106-1716
US

IV. Provider business mailing address

11100 EUCLID AVE DEPARTMENT OF OPHTHALMOLOGY UH
CLEVELAND OH
44106
US

V. Phone/Fax

Practice location:
  • Phone: 520-742-7444
  • Fax: 520-297-2267
Mailing address:
  • Phone: 216-844-3601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number52816
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number35.134993
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: