Healthcare Provider Details

I. General information

NPI: 1659335388
Provider Name (Legal Business Name): VERA F HUPERTZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 11/03/2021
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE # DESKR3
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

9500 EUCLID AVE DEPT R3
CLEVELAND OH
44195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 216-444-0964
  • Fax: 216-444-2974
Mailing address:
  • Phone: 216-444-0964
  • Fax: 216-444-2974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number35051219H
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2080T0004X
TaxonomyPediatric Transplant Hepatology Physician
License Number35051219H
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: