Healthcare Provider Details

I. General information

NPI: 1447575543
Provider Name (Legal Business Name): UNIVERSITY HOSPITALS MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2010
Last Update Date: 04/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 CLAGUE RD SUITE 2200
WESTLAKE OH
44145-1582
US

IV. Provider business mailing address

3605 WARRENSVILLE CENTER RD OFFICE 1342
SHAKER HEIGHTS OH
44122-5203
US

V. Phone/Fax

Practice location:
  • Phone: 216-286-6296
  • Fax: 216-286-6341
Mailing address:
  • Phone: 216-286-6296
  • Fax: 216-286-6341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number StateOH

VIII. Authorized Official

Name: LARRY MCELROY
Title or Position: CONTROLLER
Credential:
Phone: 216-383-6756