MEDICARE: WILHELMINA CHARLES

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	390200000X	Student in an Organized Health Care Education/Training Program		OH

General Provider Information

NPI Number	:	1437569506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILHELMINA CHARLES

Provider Business Mailing Address
First Line	:	3080 E DERBYSHIRE RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-2737
Country	:	US
Telephone Number	:	216-320-4541
Fax Number	:	216-453-2075

Provider Business Practice Location Address
First Line	:	3665 MONTICELLO BLVD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44121-1581
Country	:	US
Telephone Number	:	216-320-3719
Fax Number	:	216-320-5606

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/29/2014
Last Update Date	:	04/29/2014

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Directions to “ WILHELMINA CHARLES ” Practice Location

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