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General NPI Number Information
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NPI Number | 1740275684
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Entity Type | Organization
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Legal Business Name | TESSY MERIDORES MD INC
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Dates
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Enumeration Date | 09/16/2005
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Last Update Date | 08/28/2014
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Provider Practice Location Address
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Address Line | 18099 LORAIN AVE STE 316
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City | CLEVELAND
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State | OH
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Zip | 44111-5610
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Country | US
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Telephone | 216-252-2950
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Fax | 216-251-8760
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Provider Business Mailing Address
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Address Line | PO BOX 451198
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City | WESTLAKE
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State | OH
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Zip | 44145-0630
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Country | US
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Telephone | 216-252-2950
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Fax | 216-251-8760
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Authorized Official
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Title or Position | PRESIDENT
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Name | TESSY MERIDORES
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Credential | MD
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Telephone | 216-252-2950
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 35065853
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License Number State | OH
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