Healthcare Provider Details

I. General information

NPI: 1902869605
Provider Name (Legal Business Name): MICHELLE JAWORSKI STEHURA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE ANGELIQUE JAWORSKI MD

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 04/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 EUCLID AVE DEPARTMENT OF PATHOLOGY
CLEVELAND OH
44106-1716
US

IV. Provider business mailing address

24701 EUCLID AVE 3RD. FLOOR
EUCLID OH
44117-1714
US

V. Phone/Fax

Practice location:
  • Phone: 216-368-2482
  • Fax: 216-844-1810
Mailing address:
  • Phone: 216-383-6950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number35-093179
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number35-093179
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number35-093179
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35093179
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: