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General NPI Number Information
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NPI Number | 1518289032
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Entity Type | Organization
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Legal Business Name | UNIVERSITY HOSPITALS MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 02/25/2010
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Last Update Date | 02/25/2010
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Provider Practice Location Address
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Address Line | 27100 CHARDON RD 3RD FLOOR
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City | RICHMOND HTS
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State | OH
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Zip | 44143-1116
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Country | US
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Telephone | 440-585-7070
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Fax |
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Provider Business Mailing Address
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Address Line | 3605 WARRENSVILLE CENTER RD 1ST FLOOR
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City | SHAKER HTS
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State | OH
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Zip | 44122-5203
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Country | US
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Telephone | 216-286-6260
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Fax | 216-286-6341
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Authorized Official
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Title or Position | PROVIDER ENROLLMENT
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Name | LARRY MCELROY
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Credential |
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Telephone | 216-286-6260
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State | OH
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