Healthcare Provider Details

I. General information

NPI: 1043042914
Provider Name (Legal Business Name): MADELEINE BUHROW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2024
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5813 MAYFIELD RD
MAYFIELD HTS OH
44124-2932
US

IV. Provider business mailing address

5813 MAYFIELD RD
MAYFIELD HTS OH
44124-2932
US

V. Phone/Fax

Practice location:
  • Phone: 216-394-3941
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2308696
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: