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General NPI Number Information
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NPI Number | 1942530506
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Entity Type | Organization
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Legal Business Name | CEDARNILE LLC
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Dates
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Enumeration Date | 01/05/2010
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Last Update Date | 01/11/2010
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Provider Practice Location Address
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Address Line | 14805 DETROIT AVE
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City | LAKEWOOD
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State | OH
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Zip | 44107-3934
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Country | US
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Telephone | 330-576-5600
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1243
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City | BATH
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State | OH
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Zip | 44210-1243
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Country | US
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Telephone | 330-576-5600
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Fax |
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Authorized Official
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Title or Position | PARTNERSHIP
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Name | DR. SAMIR JOSEPH SHAIA
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Credential | DO
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Telephone | 330-567-5600
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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 |
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License Number State |
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