MEDICARE: SUMAI MEDICAL, 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	174400000X	Specialist

General Provider Information

NPI Number	:	1285817171
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUMAI MEDICAL, INC

Provider Business Mailing Address
First Line	:	PO BOX 8124
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44505-8124
Country	:	US
Telephone Number	:	330-759-9233
Fax Number	:

Provider Business Practice Location Address
First Line	:	2842 E OVERLOOK RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-2432
Country	:	US
Telephone Number	:	330-759-9233
Fax Number	:

Authorized Official
Title or Position	:	BILLING
Name	:	BRUCE BURGDORF
Credential	:
Telephone Number	:	330-759-9233

Provider Enumeration Date	:	12/13/2007
Last Update Date	:	12/13/2007

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