Individual
IAN PAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11100 EUCLID AVE, CLEVELAND, OH 44106-1716
(216) 844-1000
Mailing address
11100 EUCLID AVE, CLEVELAND, OH 44106-1716
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
036.177005
IL
2085R0202X
Diagnostic Radiology Physician
Primary
1024505
MA
2085R0202X
Diagnostic Radiology Physician
2025-02936
NC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/24/2020
Last updated
04/28/2026
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