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General NPI Number Information
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NPI Number | 1750690657
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Entity Type | Organization
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Legal Business Name | CLEVELAND HEALTH MANAGEMENT INC
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Dates
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Enumeration Date | 09/27/2010
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Last Update Date | 09/27/2010
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Provider Practice Location Address
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Address Line | 11201 SHAKER BLVD
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City | CLEVELAND
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State | OH
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Zip | 44104-3869
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Country | US
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Telephone | 216-548-6244
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Fax |
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Provider Business Mailing Address
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Address Line | 16781 CHAGRIN BLVD # 282
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City | SHAKER HEIGHTS
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State | OH
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Zip | 44120-3721
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Country | US
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Telephone | 216-548-6244
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. ALFRED GUS KIOUS
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Credential | M.D.
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Telephone | 216-548-6244
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35042555
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License Number State | OH
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