Basic Information
| Provider Information | |||||||||
| NPI: | 1548219678 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ERGUN | ||||||||
| FirstName: | HULUSI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3605 WARRENSVILLE CTR RD | ||||||||
| Address2: | MSC9152 | ||||||||
| City: | SHAKER HTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2162866299 | ||||||||
| FaxNumber: | 2162866341 | ||||||||
| Practice Location | |||||||||
| Address1: | 11100 EUCLID AVENUE | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2168441700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2006 | ||||||||
| LastUpdateDate: | 05/23/2008 | ||||||||
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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 | 2085R0202X | 35044418 | OH | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 4676662 | 01 | OH | AETNA | OTHER | 000000545398 | 01 | OH | ANTHEM | OTHER | P00412321 | 01 | OH | RAILROAD MEDICARE | OTHER | 000000229277 | 01 | OH | UNISON | OTHER | 421780 | 01 | OH | WELLCARE | OTHER | 0488897 | 05 | OH | MEDICAID | 0304914 | 01 | OH | BCMH | OTHER | ER0509955 | 01 | OH | PIN | OTHER | 751482 | 01 | OH | BUCKEYE | OTHER |