MEDICARE: UNIVERSITY HOSPITALS MEDICAL GROUP, INC

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	2085B0100X	Body Imaging Physician		OH
2	2085R0202X	Diagnostic Radiology Physician		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

General Provider Information

NPI Number	:	1679897359
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY HOSPITALS MEDICAL GROUP, INC

Provider Business Mailing Address
First Line	:	3605 WARRENSVILLE CENTER RD
Second Line	:	OFFICE 1342
City	:	SHAKER HEIGHTS
State	:	OH
Zip	:	44122-5203
Country	:	US
Telephone Number	:	216-286-6296
Fax Number	:	216-286-6341

Provider Business Practice Location Address
First Line	:	18599 LAKE SHORE BLVD
Second Line	:	SUITE 111
City	:	EUCLID
State	:	OH
Zip	:	44119-1093
Country	:	US
Telephone Number	:	216-286-6296
Fax Number	:	216-286-6341

Authorized Official
Title or Position	:	CONTROLLER
Name	:	LARRY MCELROY
Credential	:
Telephone Number	:	216-383-6756

Provider Enumeration Date	:	03/24/2010
Last Update Date	:	03/24/2010

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