Healthcare Provider Details

I. General information

NPI: 1093904476
Provider Name (Legal Business Name): CUSTOMCARE MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2007
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 ALLEN BRADLEY DR STE 240
MAYFIELD HEIGHTS OH
44124-6130
US

IV. Provider business mailing address

300 ALLEN BRADLEY DR STE 240
MAYFIELD HEIGHTS OH
44124-6130
US

V. Phone/Fax

Practice location:
  • Phone: 216-382-8000
  • Fax: 216-297-3233
Mailing address:
  • Phone: 216-382-8000
  • Fax: 216-297-3233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number52123
License Number StateOH

VIII. Authorized Official

Name: DR. RICHARD TOMM
Title or Position: PARTNER
Credential: M.D.
Phone: 216-382-8000