Healthcare Provider Details

I. General information

NPI: 1861492142
Provider Name (Legal Business Name): RICHARD UNGVARSKY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 01/12/2021
Certification Date: 01/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6707 POWERS BLVD STE 100
PARMA OH
44129-5463
US

IV. Provider business mailing address

PO BOX 931591
CLEVELAND OH
44193-1719
US

V. Phone/Fax

Practice location:
  • Phone: 740-743-4034
  • Fax:
Mailing address:
  • Phone: 440-743-4281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35-05-4595-U
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: