MEDICARE: SOUTHWEST CLEVELAND SLEEP CENTER

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	207RS0012X	Sleep Medicine (Internal Medicine) Physician	35064077	OH

General Provider Information

NPI Number	:	1124256094
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST CLEVELAND SLEEP CENTER

Provider Business Mailing Address
First Line	:	17900 JEFFERSON PARK RD STE 102
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44130-3437
Country	:	US
Telephone Number	:	440-239-7533
Fax Number	:	440-237-2585

Provider Business Practice Location Address
First Line	:	6820 RIDGE RD STE 204
Second Line	:
City	:	PARMA
State	:	OH
Zip	:	44129-5647
Country	:	US
Telephone Number	:	440-239-7533
Fax Number	:	440-239-2585

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MANSOOR AHMED
Credential	:	M.D.
Telephone Number	:	440-239-7533

Provider Enumeration Date	:	06/30/2009
Last Update Date	:	06/30/2009

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