Organization
MAIN STREET MEDICAL GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RANDALL SCOTT SCHWARTZ M.D. (PROPRIETOR)
(440) 946-4662
Entity
Organization
Contact information
Practice address
7190 COTTESMORE LN, SOLON, OH 44139-4702
(440) 349-1983
(440) 349-1983
Mailing address
36001 EUCLID AVE, C-17, WILLOUGHBY, OH 44094-4643
(440) 946-4662
(440) 946-4084
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
35-06-0015
OH
261QP2300X
Primary Care Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000562822
ANTHEM BLUE SHIELD
OH
05
—
2817321
—
OH
Enumeration date
03/21/2008
Last updated
08/18/2023
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