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General NPI Number Information
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NPI Number | 1265512669
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Entity Type | Individual
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Provider Name | STEPHEN MARICICH MD
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Gender | Male
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 10/01/2012
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Provider Practice Location Address
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Address Line | 10900 EUCLID AVENUE CASE WESTERN RESERVE UNIVERSITY SOM ROOM E750I
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City | CLEVELAND
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State | OH
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Zip | 44106
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Country | US
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Telephone | 216-368-2194
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Fax | 216-368-4650
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Provider Business Mailing Address
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Address Line | 24701 EUCLID AVE 3RD FLOOR
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City | EUCLID
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State | OH
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Zip | 44117-1714
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Country | US
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Telephone |
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Fax |
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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 | 2084N0402X
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Taxonomy Name | Neurology with Special Qualifications in Child Neurology Physician
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License Number | M3010
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2084N0402X
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Taxonomy Name | Neurology with Special Qualifications in Child Neurology Physician
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License Number | 35-091986
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License Number State | OH
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