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General NPI Number Information
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NPI Number | 1306608948
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Entity Type | Individual
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Provider Name | DANIEL KENNETH CLEGG
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Gender | Male
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Dates
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Enumeration Date | 01/29/2024
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Last Update Date | 01/29/2024
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Provider Practice Location Address
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Address Line | 5555 TRANSPORTATION BLVD
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City | GARFIELD HEIGHTS
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State | OH
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Zip | 44125-5371
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Country | US
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Telephone | 877-440-8326
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Fax |
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Provider Business Mailing Address
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Address Line | 18803 WINDWARD WAY
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City | STRONGSVILLE
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State | OH
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Zip | 44136-7122
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Country | US
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Telephone | 330-671-1367
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 50.008631RX
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License Number State | OH
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