Healthcare Provider Details

I. General information

NPI: 1750136966
Provider Name (Legal Business Name): STACY PLOOM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2024
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE # JJ24
CLEVELAND OH
44195-0002
US

IV. Provider business mailing address

9500 EUCLID AVE # JJ24
CLEVELAND OH
44195-0002
US

V. Phone/Fax

Practice location:
  • Phone: 216-444-2200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number57.261137
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR80826
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: