Healthcare Provider Details

I. General information

NPI: 1073682209
Provider Name (Legal Business Name): CDC PHYSICIANS ORGANIZATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18720 CHAGRIN BLVD
SHAKER HEIGHTS OH
44122-4855
US

IV. Provider business mailing address

18720 CHAGRIN BLVD
SHAKER HEIGHTS OH
44122-4855
US

V. Phone/Fax

Practice location:
  • Phone: 216-295-7003
  • Fax: 216-295-7014
Mailing address:
  • Phone: 216-295-7003
  • Fax: 216-295-7014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number35062206
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number35081307
License Number StateOH

VIII. Authorized Official

Name: GAYLE A NEMECEK
Title or Position: COO
Credential:
Phone: 216-658-0458