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General NPI Number Information
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NPI Number | 1205934130
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Entity Type | Individual
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Provider Name | JUDITH A ADAMICH PAC
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Gender | Female
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 01/06/2021
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Provider Practice Location Address
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Address Line | 18599 LAKESHORE #200
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City | EUCLID
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State | OH
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Zip | 44119
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Country | US
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Telephone | 216-383-0100
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Fax | 216-383-6481
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Provider Business Mailing Address
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Address Line | PO BOX 74571
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City | CLEVELAND
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State | OH
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Zip | 44194
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Country | US
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Telephone | 216-383-6480
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Fax | 216-383-6745
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 50001228
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License Number State | OH
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