Healthcare Provider Details

I. General information

NPI: 1801822366
Provider Name (Legal Business Name): NORTHEAST OHIO GROUP PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29000 CENTER RIDGE RD
WESTLAKE OH
44145-5293
US

IV. Provider business mailing address

30680 BAINBRIDGE RD
SOLON OH
44139-2282
US

V. Phone/Fax

Practice location:
  • Phone: 440-542-5023
  • Fax:
Mailing address:
  • Phone: 440-542-5023
  • Fax: 440-542-5029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINE MORRISON
Title or Position: VICE-PRESIDENT
Credential:
Phone: 440-542-5000