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 State
1	207RH0003X	Hematology & Oncology Physician	OH
2	208800000X	Urology Physician	OH
3	208600000X	Surgery 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	:	1992006241
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY HOSPITALS MEDICAL GROUP, INC.

Provider Business Mailing Address
First Line	:	24701 EUCLID AVE
Second Line	:	3RD FLOOR
City	:	EUCLID
State	:	OH
Zip	:	44117-1714
Country	:	US
Telephone Number	:	216-383-6616
Fax Number	:

Provider Business Practice Location Address
First Line	:	5885 LANDERBROOK DR
Second Line	:	SUITE 100
City	:	MAYFIELD HTS
State	:	OH
Zip	:	44124-4045
Country	:	US
Telephone Number	:	440-460-1616
Fax Number	:

Authorized Official
Title or Position	:	VP OF FINANCE
Name	:	LARRY MCELROY
Credential	:
Telephone Number	:	216-383-6616

Provider Enumeration Date	:	11/03/2010
Last Update Date	:	11/03/2010

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Directions to “UNIVERSITY HOSPITALS MEDICAL GROUP, INC. ” Practice Location

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