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Specialty details in registry · Wickliffe, OH

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At a glance

1460 Rockefeller Rd, Wickliffe, OH 44092-1932

NPPES record updated Oct 2, 2023. Public records can lag behind changes at a practice.

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Practice location

1460 Rockefeller Rd
Wickliffe, OH 44092-1932

Professional details: NPI, taxonomy & registry record

NPI1306626999

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Registry details

Primary taxonomy: Specialty details in registry
Taxonomy code: 261QM0801X
Enumeration date: Oct 2, 2023
Record updated: Oct 2, 2023

More registry details

Provider type: Organization · Type 2

Reported taxonomies and licenses

Specialty details in registry

261QM0801X · Primary

License numbers and credentials are reported to NPPES; HCPList does not independently verify them.

Practice location

1460 Rockefeller Rd
Wickliffe, OH 44092-1932

Phone: (440) 799-7559

Mailing address

30799 PINETREE RD # 240

PEPPER PIKE, OH 441245903

Source: NPPES Source through Oct 18, 2026An NPI does not verify licensure or credentials.

Information may be outdated or incomplete. Confirm details directly with the practice. HCPList is an independent directory and is not affiliated with CMS.

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