Healthcare Provider Details

I. General information

NPI: 1003499427
Provider Name (Legal Business Name): SIDDHARTH PATEL PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2021
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

9500 EUCLID AVE
CLEVELAND OH
44195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 216-444-2273
  • Fax:
Mailing address:
  • Phone: 216-445-1472
  • Fax: 216-445-1767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number50.009800RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: