Healthcare Provider Details

I. General information

NPI: 1700971694
Provider Name (Legal Business Name): JOHN PAUL BIRDSELL PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JOHN PAUL BIRDSELL PA-C

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 08/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7426 GOODWALT AVE
CLEVELAND OH
44102-2033
US

IV. Provider business mailing address

8787 BROOKPARK RD
PARMA OH
44129-6809
US

V. Phone/Fax

Practice location:
  • Phone: 216-832-3394
  • Fax:
Mailing address:
  • Phone: 216-739-7000
  • Fax: 216-739-7094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number50 000903
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: