MEDICARE: MICHAEL WAYNE CRUISE MD PHD

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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	D74960	MD

General Provider Information

NPI Number	:	1922201722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL WAYNE CRUISE MD PHD

Provider Business Mailing Address
First Line	:	7072 SOUTHWOODS LN
Second Line	:
City	:	SOLON
State	:	OH
Zip	:	44139-5105
Country	:	US
Telephone Number	:	216-218-8695
Fax Number	:

Provider Business Practice Location Address
First Line	:	9500 EUCLID AVE # L25
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44195-0005
Country	:	US
Telephone Number	:	216-444-0492
Fax Number	:

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

Provider Enumeration Date	:	06/08/2007
Last Update Date	:	12/28/2022

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