MEDICARE: WILLY MARCOS VALENCIA RODRIGO 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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	35.146649	OH
2	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	35.146649	OH

General Provider Information

NPI Number	:	1801006671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLY MARCOS VALENCIA RODRIGO MD

Provider Business Mailing Address
First Line	:	9500 EUCLID AVE # F20
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44195-0002
Country	:	US
Telephone Number	:	216-445-3784
Fax Number	:

Provider Business Practice Location Address
First Line	:	9500 EUCLID AVE # F20
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44195-0002
Country	:	US
Telephone Number	:	216-445-3784
Fax Number	:

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

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	11/17/2022

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