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Organization

ST JUDES MEDICAL CLINIC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. NELIDA R ENRIQUE MD (PRESIDENT TREASURER)
(216) 271-1947
Entity
Organization

Contact information

Practice address
7211 BROADWAY, CLEVELAND, OH 44105
(216) 271-1947
(216) 271-0106
Mailing address
7211 BROADWAY, CLEVELAND, OH 44105
(216) 271-1947
(216) 271-0106

Taxonomy

Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
35033404
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0325866
OH
Enumeration date
08/04/2006
Last updated
02/22/2010
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