Healthcare Provider Details

I. General information

NPI: 1407843162
Provider Name (Legal Business Name): EDWIN L CAPULONG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: EDWIN L CAPULONG MD

II. Dates (important events)

Enumeration Date: 09/28/2005
Last Update Date: 11/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 EUCLID AVE
CLEVELAND OH
44106-1716
US

IV. Provider business mailing address

8055 MAYFIELD RD STE 105
CHESTERLAND OH
44026-2447
US

V. Phone/Fax

Practice location:
  • Phone: 216-844-3004
  • Fax: 216-844-1548
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number35.084735
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number35.084735
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: