Healthcare Provider Details

I. General information

NPI: 1265509053
Provider Name (Legal Business Name): CLEVELAND UROLOGY ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10500 ANTENUCCI BLVD, SUITE 101
GARFIELD HEIGHTS OH
44125
US

IV. Provider business mailing address

10500 ANTENUCCI BLVD, SUITE 101
GARFIELD HEIGHTS OH
44125
US

V. Phone/Fax

Practice location:
  • Phone: 440-891-6500
  • Fax: 440-891-1196
Mailing address:
  • Phone: 440-891-6500
  • Fax: 440-891-1196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: KALISH R. KEDIA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 440-891-6500