Healthcare Provider Details

I. General information

NPI: 1053649491
Provider Name (Legal Business Name): UNIVERSITY HOSPITALS MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2009
Last Update Date: 04/01/2022
Certification Date: 04/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5850 LANDERBROOK DR SUITE 220
MAYFIELD HTS OH
44124-6531
US

IV. Provider business mailing address

3605 WARRENSVILLE CENTER RD 1ST FLOOR
SHAKER HTS OH
44122-5203
US

V. Phone/Fax

Practice location:
  • Phone: 216-844-7700
  • Fax:
Mailing address:
  • Phone: 216-286-6260
  • Fax: 216-286-6341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateOH

VIII. Authorized Official

Name: DR. CHRISTOPHER MILLER
Title or Position: CMO
Credential: MD
Phone: 513-558-8090