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General NPI Number Information
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NPI Number | 1730929464
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Entity Type | Organization
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Legal Business Name | CLEVELAND MEDICAL MANAGEMENT LLC
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Dates
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Enumeration Date | 05/30/2024
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Last Update Date | 05/30/2024
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Provider Practice Location Address
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Address Line | 700 MONROE RD
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City | LEBANON
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State | OH
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Zip | 45036-1409
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Country | US
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Telephone | 513-465-6268
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 286
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City | TRENTON
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State | OH
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Zip | 45067-0286
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VP
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Name | CORBY JOHNSON
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Credential |
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Telephone | 513-465-6268
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State |
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