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NPI Code Detail

MEDICARE: DR. NAILIL FUNDORA

MEDICARE: DR. NAILIL FUNDORA
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
1390200000XStudent in an Organized Health Care Education/Training ProgramOH

General Provider Information

NPI Number : 1073441762
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NAILIL FUNDORA
Provider Business Mailing Address
First Line : 22901 MILLCREEK BLVD STE 200
Second Line :
City : BEACHWOOD
State : OH
Zip : 44122-5721
Country : US
Telephone Number : 440-672-7594
Fax Number :
Provider Business Practice Location Address
First Line : 22901 MILLCREEK BLVD STE 200
Second Line :
City : BEACHWOOD
State : OH
Zip : 44122-5721
Country : US
Telephone Number : 440-672-7594
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2026
Last Update Date : 05/12/2026

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Directions to “ DR. NAILIL FUNDORA ” Practice Location

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