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1548217250

NPI Code Detail

MEDICARE: JAMES EDWARD FUDURIC MD

MEDICARE: JAMES EDWARD FUDURIC 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	207P00000X	Emergency Medicine Physician	35038694	OH
2	2080A0000X	Pediatric Adolescent Medicine Physician	35038694	OH

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
2	942460636238	OTHER	OH	CARESOURCE

General Provider Information

NPI Number	:	1548217250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES EDWARD FUDURIC MD

Provider Business Mailing Address
First Line	:	21986 WOODFIELD TRL
Second Line	:
City	:	STRONGSVILLE
State	:	OH
Zip	:	44149-9203
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	18697 BAGLEY RD
Second Line	:
City	:	MIDDLEBURG HEIGHTS
State	:	OH
Zip	:	44130-3417
Country	:	US
Telephone Number	:	440-816-8000
Fax Number	:

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

Provider Enumeration Date	:	05/28/2006
Last Update Date	:	12/03/2012

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Directions to “ JAMES EDWARD FUDURIC MD” Practice Location

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