Individual
MARIA AILEENMICHELLE P MEDINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
12000 MCCRACKEN RD, SUITE 206, GARFIELD HEIGHTS, OH 44125-2964
(216) 584-7840
(216) 584-7860
Mailing address
12000 MCCRACKEN RD, SUITE 206, GARFIELD HEIGHTS, OH 44125-2964
(216) 584-7840
(216) 584-7860
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
74782
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2741322
—
OH
01
—
400779
WELLCARE
OH
Enumeration date
07/22/2006
Last updated
10/11/2007
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