MEDICARE: SISI LU

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	208600000X	Surgery Physician	35.150840	OH

General Provider Information

NPI Number	:	1003470725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SISI LU

Provider Business Mailing Address
First Line	:	128 E APPLE ST STE 7000
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45409-2902
Country	:	US
Telephone Number	:	937-208-4953
Fax Number	:

Provider Business Practice Location Address
First Line	:	9500 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44195-2902
Country	:	US
Telephone Number	:	216-444-2200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/29/2019
Last Update Date	:	06/25/2024

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Directions to “ SISI LU ” Practice Location

Language	Start Address	Practice Location

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