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NPI Code Detail

MEDICARE: ED GEMERCHAK III

MEDICARE: ED GEMERCHAK III
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
1104100000XSocial WorkerI0800146-SUPVOH

General Provider Information

NPI Number : 1306397567
Entity Type Code : Individual
Provider Name (Legal Business Name) : ED GEMERCHAK III
Provider Business Mailing Address
First Line : 3686 NORMANDY RD
Second Line :
City : SHAKER HEIGHTS
State : OH
Zip : 44120-5254
Country : US
Telephone Number : 216-217-1637
Fax Number :
Provider Business Practice Location Address
First Line : 6001 WOODLAND AVE STE 703
Second Line :
City : CLEVELAND
State : OH
Zip : 44104-2775
Country : US
Telephone Number : 216-431-2018
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/21/2016
Last Update Date : 10/21/2016

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Directions to “ ED GEMERCHAK III ” Practice Location

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