MEDICARE: EUN JOO PARK MD

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	207RR0500X	Rheumatology Physician	01080678A	IN
2	208M00000X	Hospitalist Physician	01080678A	IN
3	207R00000X	Internal Medicine Physician	35.144300	OH
4	207R00000X	Internal Medicine Physician	01080678A	IN

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	:	1447563366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EUN JOO PARK MD

Provider Business Mailing Address
First Line	:	17310 BUCKTHORN DR
Second Line	:
City	:	CHAGRIN FALLS
State	:	OH
Zip	:	44023-1412
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9500 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44195-1239
Country	:	US
Telephone Number	:	216-538-5686
Fax Number	:

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

Provider Enumeration Date	:	07/20/2010
Last Update Date	:	03/28/2025

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Directions to “ EUN JOO PARK MD” Practice Location

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