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NPI Code Detail

MEDICARE: NORTH EAST OHIO GROUP PRACTICE LLC

MEDICARE: NORTH EAST OHIO GROUP PRACTICE LLC
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
1207R00000XInternal Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1063575462
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTH EAST OHIO GROUP PRACTICE LLC
Provider Business Mailing Address
First Line : 30575 BAINBRIDGE RD STE 200
Second Line :
City : CLEVELAND
State : OH
Zip : 44139-2275
Country : US
Telephone Number : 440-542-5000
Fax Number : 440-542-5005
Provider Business Practice Location Address
First Line : 18697 BAGLEY RD
Second Line :
City : MIDDLEBURG HEIGHTS
State : OH
Zip : 44130-3417
Country : US
Telephone Number : 440-542-5000
Fax Number : 440-542-5005
Authorized Official
Title or Position : CFO
Name : SCOTT KLOSTERMAN
Credential :
Telephone Number : 330-926-7974
Provider Enumeration Date : 12/18/2006
Last Update Date : 04/21/2026

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Directions to “NORTH EAST OHIO GROUP PRACTICE LLC ” Practice Location

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