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General NPI Number Information
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NPI Number | 1598841835
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Entity Type | Organization
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Legal Business Name | EUCLID PEDIATRICS INC
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Dates
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Enumeration Date | 10/30/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7200 CENTER ST STE 200
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City | MENTOR
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State | OH
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Zip | 44060-4900
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Country | US
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Telephone | 440-255-0706
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Fax | 440-255-4451
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Provider Business Mailing Address
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Address Line | 26250 EUCLID AVE STE 611
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City | EUCLID
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State | OH
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Zip | 44132-3305
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Country | US
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Telephone | 216-261-2606
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Fax | 216-261-9814
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Authorized Official
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Title or Position | PARTNER
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Name | DANIEL G FULLER
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Credential | MD
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Telephone | 216-261-2606
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 35041455
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License Number State | OH
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