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	208000000X	Pediatrics 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	:	1104059633
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	:	10524 EUCLID AVE
Second Line	:	SUITE 3150
City	:	CLEVELAND
State	:	OH
Zip	:	44106-2205
Country	:	US
Telephone Number	:	216-844-7700
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT OF FINANCE
Name	:	LARRY MCELROY
Credential	:
Telephone Number	:	216-767-8717

Provider Enumeration Date	:	09/01/2009
Last Update Date	:	09/01/2009

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