Healthcare Provider Details

I. General information

NPI: 1417063769
Provider Name (Legal Business Name): MICHAEL V BARANAUSKAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9485 MENTOR AVE STE 210
MENTOR OH
44060-8723
US

IV. Provider business mailing address

9485 MENTOR AVE STE 210
MENTOR OH
44060-8723
US

V. Phone/Fax

Practice location:
  • Phone: 440-205-5747
  • Fax: 440-205-5735
Mailing address:
  • Phone: 440-205-5747
  • Fax: 440-205-5735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35-071406
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: