MEDICARE: CLEVELAND URGENT CARE 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
1	261QP2300X	Primary Care Clinic/Center
2	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1093478976
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLEVELAND URGENT CARE LLC

Provider Business Mailing Address
First Line	:	14529 PURITAS AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44135-2813
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14529 PURITAS AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44135-2813
Country	:	US
Telephone Number	:	216-476-1400
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ABEDALHAKEEM ABUKHALIL
Credential	:	DR
Telephone Number	:	440-554-7025

Provider Enumeration Date	:	10/18/2021
Last Update Date	:	10/18/2021

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Directions to “CLEVELAND URGENT CARE LLC ” Practice Location

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