Basic Information
| Provider Information | |||||||||
| NPI: | 1295902914 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CLEVELAND CLINIC FOUNDATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2680 N MORELAND BLVD | ||||||||
| Address2: | APT #606 | ||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441201472 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2162583226 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9500 EUCLID AVE | ||||||||
| Address2: | H35 | ||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441950001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2164442200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2008 | ||||||||
| LastUpdateDate: | 05/12/2008 | ||||||||
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| AuthorizedOfficialLastName: | TANTIWONGKOSRI | ||||||||
| AuthorizedOfficialFirstName: | KRIANGKRAI | ||||||||
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| AuthorizedOfficialTitleorPosition: | CLINICAL FELLOW | ||||||||
| AuthorizedOfficialTelephone: | 2164442200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | Y | Hospitals | General Acute Care Hospital |
No ID Information.