Individual
STEPHANIE CONWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
18101 LORAIN AVE, CLEVELAND, OH 44111-5612
(216) 476-7213
Mailing address
21091 W WAGAR CIR, ROCKY RIVER, OH 44116-2320
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
35057279
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0747393
—
OH
01
—
930008866
MEDICARE TRAVELERS RR-GA
OH
01
—
942460636278
CARESOURCE
OH
Enumeration date
06/07/2006
Last updated
07/07/2014
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