Healthcare Provider Details

I. General information

NPI: 1720176548
Provider Name (Legal Business Name): EUCLID PEDIATRICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26250 EUCLID AVE STE 611
EUCLID OH
44132-3305
US

IV. Provider business mailing address

26250 EUCLID AVE STE 611
EUCLID OH
44132-3305
US

V. Phone/Fax

Practice location:
  • Phone: 216-261-2606
  • Fax: 216-261-9814
Mailing address:
  • Phone: 216-261-2606
  • Fax: 216-261-9814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35041455
License Number StateOH

VIII. Authorized Official

Name: DANIEL G FULLER
Title or Position: PARTNER
Credential: MD
Phone: 216-261-2606