Healthcare Provider Details

I. General information

NPI: 1326052093
Provider Name (Legal Business Name): GEORGE J PICHA MD PHD FACS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5005 ROCKSIDE RD STE 640
INDEPENDENCE OH
44131-6808
US

IV. Provider business mailing address

5005 ROCKSIDE RD STE 640
INDEPENDENCE OH
44131-6808
US

V. Phone/Fax

Practice location:
  • Phone: 216-328-0800
  • Fax: 216-328-1860
Mailing address:
  • Phone: 216-328-0800
  • Fax: 216-328-1860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number35-05-1876-P
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: