=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619943388
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAYANTILAL D BHIMANI MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/23/2006
-----------------------------------------------------
Last Update Date | 09/13/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1730 W 25TH ST STE 2E
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44113-3108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-696-4140
-----------------------------------------------------
Fax | 216-363-2058
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20525 CENTER RIDGE ROAD SUITE 220
-----------------------------------------------------
City | ROCKY RIVER
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44116
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-895-5056
-----------------------------------------------------
Fax | 440-333-2935
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 35067464B
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------