Basic Information
| Provider Information | |||||||||
| NPI: | 1245599786 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNIVERSITY HOSPITALS RICHMOND MEDICAL CENTER | ||||||||
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| OtherOrganizationName: | UNIVERSITY HOSPITALS OF CLEVELAND- RICHMOND MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 27100 CHARDON ROAD | ||||||||
| Address2: | DEPARTMENT OF MEDICAL EDUCATION | ||||||||
| City: | RICHMOND HTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2019542024 | ||||||||
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| Practice Location | |||||||||
| Address1: | 27100 CHARDON RD | ||||||||
| Address2: | DEPARTMENT OF MEDICAL EDUCATION | ||||||||
| City: | RICHMOND HTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441431116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4405854821 | ||||||||
| FaxNumber: | 4405856141 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2012 | ||||||||
| LastUpdateDate: | 05/03/2012 | ||||||||
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| AuthorizedOfficialLastName: | ROWANE | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | P. | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR-OSTEOPATHIC MEDICAL EDU | ||||||||
| AuthorizedOfficialTelephone: | 4409436350 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | UNIVERSITY HOSPITALS HEALTH SYSTEM, INC. | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | D.O. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | 193200000X MULTI-SPECIALTY GROUP | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.