Basic Information
| Provider Information | |||||||||
| NPI: | 1093026544 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | POSLUSZNY | ||||||||
| FirstName: | STEPHEN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3461 WARRENSVILLE CENTER RD | ||||||||
| Address2: | |||||||||
| City: | SHAKER HEIGHTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441225260 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2169914180 | ||||||||
| FaxNumber: | 2169917329 | ||||||||
| Practice Location | |||||||||
| Address1: | 11000 EUCLID AVE | ||||||||
| Address2: | UNIVERSITY HOSPITALS CASE MEDICAL CENTER | ||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441061714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2168447700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2010 | ||||||||
| LastUpdateDate: | 01/10/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 35-120994 | OH | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 0089381 | 05 | OH | MEDICAID |