Healthcare Provider Details

I. General information

NPI: 1225247406
Provider Name (Legal Business Name): EDGARD ANDRE BENDALY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE
CLEVELAND OH
44195-5074
US

IV. Provider business mailing address

9500 EUCLID AVE
CLEVELAND OH
44195-5074
US

V. Phone/Fax

Practice location:
  • Phone: 216-636-1166
  • Fax:
Mailing address:
  • Phone: 216-636-1166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number40907
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number8561
License Number StateSD
# 3
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number35.137251
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: