Healthcare Provider Details

I. General information

NPI: 1336602218
Provider Name (Legal Business Name): UNIVERSITY HOSPITALS REGIONAL PRACTICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2019
Last Update Date: 08/04/2023
Certification Date: 08/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3605 WARRENSVILLE CENTER RD
SHAKER HEIGHTS OH
44122-5203
US

IV. Provider business mailing address

PO BOX 772928
DETROIT MI
48277-2937
US

V. Phone/Fax

Practice location:
  • Phone: 216-358-1424
  • Fax: 216-201-4272
Mailing address:
  • Phone: 800-589-6006
  • Fax: 216-201-4272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

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