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General NPI Number Information
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NPI Number | 1487890893
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Entity Type | Organization
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Legal Business Name | YOUR DIABETES ENDOCRINE NUTRITION GROUP, INC.
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Dates
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Enumeration Date | 01/07/2009
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Last Update Date | 02/25/2021
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Provider Practice Location Address
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Address Line | 8300 TYLER BLVD STE 102
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City | MENTOR
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State | OH
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Zip | 44060-4217
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Country | US
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Telephone | 440-266-5000
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Fax | 440-266-5004
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Provider Business Mailing Address
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Address Line | 16101 SNOW RD STE 102
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City | CLEVELAND
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State | OH
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Zip | 44142-2817
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Country | US
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Telephone | 216-898-1633
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DANIEL WEISS
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Credential | M.D.
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Telephone | 440-266-5000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 35053498
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License Number State | OH
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