MEDICARE: VJEKOSLAV JERAS MD

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	2085R0202X	Diagnostic Radiology Physician	35085436	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	:	1104899004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VJEKOSLAV JERAS MD

Provider Business Mailing Address
First Line	:	25001 EMERY RD
Second Line	:	SUITE 100
City	:	CLEVELAND
State	:	OH
Zip	:	44128-5626
Country	:	US
Telephone Number	:	216-831-9786
Fax Number	:	216-831-2425

Provider Business Practice Location Address
First Line	:	25001 EMERY RD
Second Line	:	SUITE 100
City	:	CLEVELAND
State	:	OH
Zip	:	44128-5626
Country	:	US
Telephone Number	:	216-831-9786
Fax Number	:	216-831-2425

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2006
Last Update Date	:	09/18/2012

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