=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851355770
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CASE WESTERN RESERVE UNIVERSITY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2006
-----------------------------------------------------
Last Update Date | 10/31/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10900 EUCLID AVE DOA09F
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44106-4905
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-368-3882
-----------------------------------------------------
Fax | 216-274-9260
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10900 EUCLID AVE
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44106-1712
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-368-3882
-----------------------------------------------------
Fax | 216-274-9260
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MISS JANET DRAGANIC
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 216-368-6801
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------