MEDICARE: DR. CHARLES MBANEFO M.D MRCP

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	207RN0300X	Nephrology Physician	35051577M	OH

General Provider Information

NPI Number	:	1881720886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES MBANEFO M.D MRCP

Provider Business Mailing Address
First Line	:	11201 SHAKER BLVD SUITE 130
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44104-3833
Country	:	US
Telephone Number	:	216-368-5687
Fax Number	:

Provider Business Practice Location Address
First Line	:	11201 SHAKER BLVD SUITE 130
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44104-3833
Country	:	US
Telephone Number	:	216-368-5687
Fax Number	:

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

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	01/23/2013

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