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NPI Code Detail

MEDICARE: ANDREW JIMERSON M.D.

MEDICARE:   ANDREW  JIMERSON  M.D.
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
1173000000XLegal Medicine35-141190JOH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000135949OTHEROHANTHEM
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1427056076
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREW JIMERSON M.D.
Provider Business Mailing Address
First Line : PO BOX 210146
Second Line :
City : SOUTH EUCLID
State : OH
Zip : 44121-7146
Country : US
Telephone Number : 216-721-1805
Fax Number : 216-721-4257
Provider Business Practice Location Address
First Line : 11811 SHAKER BLVD
Second Line : STE. 330
City : CLEVELAND
State : OH
Zip : 44120-1931
Country : US
Telephone Number : 216-721-1805
Fax Number : 216-721-4257
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2005
Last Update Date : 07/08/2007

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