MEDICARE: UNIVERSITY HOSPITALS MEDICAL GROUP, INC.

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	207Q00000X	Family Medicine Physician		OH

Other Identifiers

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

General Provider Information

NPI Number	:	1093947129
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY HOSPITALS MEDICAL GROUP, INC.

Provider Business Mailing Address
First Line	:	3605 WARRENSVILLE CENTER RD
Second Line	:	1ST FLOOR
City	:	SHAKER HTS
State	:	OH
Zip	:	44122-5203
Country	:	US
Telephone Number	:	216-286-6260
Fax Number	:	216-286-6341

Provider Business Practice Location Address
First Line	:	26376 JOHN RD
Second Line	:
City	:	OLMSTED FALLS
State	:	OH
Zip	:	44138-1277
Country	:	US
Telephone Number	:	216-844-3944
Fax Number	:	216-844-8974

Authorized Official
Title or Position	:	SUPV
Name	:	JOI WILLIAMS
Credential	:
Telephone Number	:	440-214-8025

Provider Enumeration Date	:	08/24/2009
Last Update Date	:	06/15/2022

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