Healthcare Provider Details

I. General information

NPI: 1295746352
Provider Name (Legal Business Name): PEIJUN CHEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 04/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 EUCLID AVE
CLEVELAND OH
44106
US

IV. Provider business mailing address

3605 WARRENSVILLE CENTER ROAD 1ST FLOOR
SHAKER HILLS OH
44122
US

V. Phone/Fax

Practice location:
  • Phone: 440-526-3030
  • Fax: 440-546-2713
Mailing address:
  • Phone: 216-286-6260
  • Fax: 216-286-6341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301076100
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number4301076100
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35.089022
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: