Individual
JAMES BLACK JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11100 EUCLID AVE, CLEVELAND, OH 44106
(216) 844-1000
Mailing address
3605 WARRENSVILLE CENTER ROAD, 1ST FLOOR, SHAKER HTS, OH 44122
(216) 286-6260
(216) 286-6341
Taxonomy
Speciality
Code
Description
License number
State
146N00000X
Basic Emergency Medical Technician
35090617
OH
207P00000X
Emergency Medicine Physician
Primary
35090617
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000226039
UNISON
OH
01
—
000000538614
ANTHEM
OH
05
—
2775644
—
OH
01
—
421771
WELLCARE MEDICAID
OH
01
—
751474
BUCKEYE MEDICAID
OH
01
—
9219089
AETNA
OH
01
—
P00432283
RAILROAD MEDICARE
OH
Enumeration date
10/15/2007
Last updated
12/29/2008
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