Healthcare Provider Details

I. General information

NPI: 1902765753
Provider Name (Legal Business Name): MEDUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6789 RIDGE RD STE 106
PARMA OH
44129-5635
US

IV. Provider business mailing address

3399 HETZEL DR
PARMA OH
44134-5119
US

V. Phone/Fax

Practice location:
  • Phone: 440-875-5090
  • Fax:
Mailing address:
  • Phone: 440-875-5090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. SERGIY GRYGORIEV
Title or Position: RN,BSN
Credential:
Phone: 216-548-9129