MEDICARE: NOBLE ROAD FAMILY PRACTICE

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1972859379
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOBLE ROAD FAMILY PRACTICE

Provider Business Mailing Address
First Line	:	2225 NOBLE RD
Second Line	:
City	:	CLEVELAND HTS
State	:	OH
Zip	:	44112-1726
Country	:	US
Telephone Number	:	216-761-0332
Fax Number	:

Provider Business Practice Location Address
First Line	:	2225 NOBLE RD
Second Line	:
City	:	CLEVELAND HTS
State	:	OH
Zip	:	44112-1726
Country	:	US
Telephone Number	:	216-761-0332
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SONYA HILL
Credential	:
Telephone Number	:	216-761-0332

Provider Enumeration Date	:	08/03/2012
Last Update Date	:	08/03/2012

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Directions to “NOBLE ROAD FAMILY PRACTICE ” Practice Location

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