| NPI | 1770082471 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY L. LONGVILLE Chief Acct Officer And Controller 216-636-7416 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 207R00000X Internal Medicine |
| Enumeration Date | 2018-02-08 |
| Last Update Date | 2022-03-31 |