Healthcare Provider Details

I. General information

NPI: 1164626073
Provider Name (Legal Business Name): MATTHEW MARK VRABEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 EUCLID AVE
CLEVELAND OH
44106-1716
US

IV. Provider business mailing address

4381 ACACIA DR
SOUTH EUCLID OH
44121-3332
US

V. Phone/Fax

Practice location:
  • Phone: 216-844-3450
  • Fax:
Mailing address:
  • Phone: 216-381-8609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number57.010620
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: