Healthcare Provider Details

I. General information

NPI: 1194304816
Provider Name (Legal Business Name): NICHOLAS SRNICK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2021
Last Update Date: 04/29/2024
Certification Date: 04/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 METROHEALTH DR
CLEVELAND OH
44109-1900
US

IV. Provider business mailing address

1726 TEMPLE AVE
MAYFIELD HTS OH
44124-3016
US

V. Phone/Fax

Practice location:
  • Phone: 216-778-4186
  • Fax:
Mailing address:
  • Phone: 440-228-7466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35.146822
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: