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 State
1	207VG0400X	Gynecology Physician	OH
2	207ZI0100X	Immunopathology Physician	OH
3	208000000X	Pediatrics Physician	OH
4	207RI0200X	Infectious Disease 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	:	1265751366
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY HOSPITALS MEDICAL GROUP, INC.

Provider Business Mailing Address
First Line	:	24701 EUCLID AVE
Second Line	:	3RD FLOOR
City	:	EUCLID
State	:	OH
Zip	:	44117-1714
Country	:	US
Telephone Number	:	216-383-6616
Fax Number	:

Provider Business Practice Location Address
First Line	:	2061 CORNELL RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44106-3808
Country	:	US
Telephone Number	:	216-844-7700
Fax Number	:

Authorized Official
Title or Position	:	CONTROLLER
Name	:	LARRY MCELROY
Credential	:
Telephone Number	:	216-383-6756

Provider Enumeration Date	:	05/28/2010
Last Update Date	:	05/28/2010

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