Basic Information
Provider Information
NPI: 1720434251
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KANERIA
FirstName: SAMIR
MiddleName: CHANDUBHAI
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2500 METROHEALTH DR
Address2:  
City: CLEVELAND
State: OH
PostalCode: 441091900
CountryCode: US
TelephoneNumber: 1627787800
FaxNumber:  
Practice Location
Address1: 12301 SNOW RD
Address2:  
City: PARMA
State: OH
PostalCode: 441301002
CountryCode: US
TelephoneNumber: 2165247377
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/13/2016
LastUpdateDate: 11/18/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 11/18/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X35.135182OHY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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