MEDICARE: DR. LUIS A LLERENA 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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	3504206	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000560687	OTHER	OH	ANTHEM BC/BS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	P00705950	OTHER	OH	RAILROAD CARE
5	P00733580	OTHER	OH	RAILROAD CARE

General Provider Information

NPI Number	:	1639164148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUIS A LLERENA MD

Provider Business Mailing Address
First Line	:	18099 LORAIN AVE
Second Line	:	SUITE 533
City	:	CLEVELAND
State	:	OH
Zip	:	44111-5610
Country	:	US
Telephone Number	:	216-251-9000
Fax Number	:	216-251-8760

Provider Business Practice Location Address
First Line	:	18099 LORAIN AVE
Second Line	:	SUITE 533
City	:	CLEVELAND
State	:	OH
Zip	:	44111-5610
Country	:	US
Telephone Number	:	216-251-9000
Fax Number	:	216-251-8760

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

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	08/31/2009

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Directions to “ DR. LUIS A LLERENA MD” Practice Location

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