Individual
DR. CLEVELAND C CLEARY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
600 EAST BLVD, EMERGENCY DEPARTMENT, ELKHART, IN 46514-2483
(574) 523-3161
(574) 523-3221
Mailing address
600 EAST BLVD, EMERGENCY DEPARTMENT, ELKHART, IN 46514-2483
(574) 523-3161
(574) 523-3221
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
01028349
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000082226
ANTHEM
IN
01
—
010029951
RAIL ROAD MEDICARE
IN
05
—
100152390
—
IN
05
—
102669202
—
MI
Enumeration date
08/16/2005
Last updated
12/20/2011
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