Healthcare Provider Details

I. General information

NPI: 1740291053
Provider Name (Legal Business Name): SHU QUE HUANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 10/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 METROHEALTH DR MHMC-PM&R
CLEVELAND OH
44109-1900
US

IV. Provider business mailing address

2500 METROHEALTH DR MHMC-PM&R
CLEVELAND OH
44109-1900
US

V. Phone/Fax

Practice location:
  • Phone: 216-778-3219
  • Fax:
Mailing address:
  • Phone: 216-778-3219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number35037476
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: