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General NPI Number Information
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NPI Number | 1073682209
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Entity Type | Organization
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Legal Business Name | CDC PHYSICIANS ORGANIZATION, INC.
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 03/03/2025
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Provider Practice Location Address
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Address Line | 18720 CHAGRIN BLVD
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City | SHAKER HEIGHTS
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State | OH
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Zip | 44122-4855
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Country | US
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Telephone | 216-295-7003
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Fax | 216-295-7014
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Provider Business Mailing Address
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Address Line | 18720 CHAGRIN BLVD
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City | SHAKER HEIGHTS
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State | OH
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Zip | 44122-4855
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Country | US
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Telephone | 216-295-7003
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Fax | 216-295-7014
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Authorized Official
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Title or Position | COO
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Name | GAYLE A NEMECEK
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Credential |
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Telephone | 216-658-0458
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 35062206
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 35081307
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License Number State | OH
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