Healthcare Provider Details

I. General information

NPI: 1104015213
Provider Name (Legal Business Name): HENRY EMIL VUCETIC MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2007
Last Update Date: 02/08/2023
Certification Date: 02/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5105 SOM CENTER ROAD SUITE 202
WILLOUGHBY OH
44094
US

IV. Provider business mailing address

7590 AUBURN ROAD, SUITE 014 ATTN: MED STAFF
CONCORD TWP OH
44077-9176
US

V. Phone/Fax

Practice location:
  • Phone: 440-953-5760
  • Fax: 440-953-5761
Mailing address:
  • Phone: 440-354-1899
  • Fax: 440-354-1845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35.092655
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number32734
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number35.092655
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: