Basic Information
| Provider Information | |||||||||
| NPI: | 1659806743 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CLEVELAND PHYSICIAN SERVICES PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1017 S TRAVIS AVE | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773275152 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2815925400 | ||||||||
| FaxNumber: | 2816599790 | ||||||||
| Practice Location | |||||||||
| Address1: | 1017 S TRAVIS AVE | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773275152 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2815925400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2017 | ||||||||
| LastUpdateDate: | 04/26/2018 | ||||||||
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| AuthorizedOfficialLastName: | BANSAL | ||||||||
| AuthorizedOfficialFirstName: | SHANTI | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGING PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 2815925400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.