Healthcare Provider Details

I. General information

NPI: 1720825557
Provider Name (Legal Business Name): UNIVERSITY HOSPITALS MEDICAL PRACTICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2024
Last Update Date: 03/17/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W. SUPERIOR AVENUE WELLNESS CENTER, FLOOR 3
CLEVELAND OH
44113
US

IV. Provider business mailing address

14600 DETROIT AVE STE 103
LAKEWOOD OH
44107-4293
US

V. Phone/Fax

Practice location:
  • Phone: 216-553-6010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DONALD DECARLO
Title or Position: CMO
Credential: MD
Phone: 440-796-8827