Healthcare Provider Details

I. General information

NPI: 1356590129
Provider Name (Legal Business Name): SUBHASH PUTHURAYA M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2008
Last Update Date: 02/04/2022
Certification Date: 02/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE # M-031
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

9500 EUCLID AVE # M-031
CLEVELAND OH
44195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 216-444-2568
  • Fax: 216-444-7625
Mailing address:
  • Phone: 216-444-2568
  • Fax: 216-444-7625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number35.124112
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: