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303 E Royalton Rd Ste 202 Cleveland OH 44147-2591 | |
(216) 743-8130 | |
(216) 743-8131 |
Full Name | |
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Speciality | Family Medicine |
Location | 303 E Royalton Rd, Cleveland, Ohio |
Authorized Official Name and Position | Sheryl Johnson (PROVIDER ENROLLMENT MANAGER) |
Authorized Official Contact | 2166921144 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 8792 Belfast ME 04915-8792 Ph: (216) 743-8130 | 303 E Royalton Rd Ste 202 Cleveland OH 44147-2591 Ph: (216) 743-8130 |
NPI Number | 1902201056 |
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Provider Enumeration Date | 10/31/2014 |
Last Update Date | 11/10/2014 |
Identifier | Type | State | Issuer |
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1902201056 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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