Organization
CLEVELAND AVENUE PROFESSIONAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MILROY J. SAMUEL M.D. (OWNER)
(614) 882-4343
Entity
Organization
Contact information
Practice address
5910 CLEVELAND AVE, COLUMBUS, OH 43231-6881
(614) 882-4343
Mailing address
200 BRADENTON AVE, DUBLIN, OH 43017-7515
(614) 793-1980
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
35075146-S
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2465738
—
OH
Enumeration date
10/04/2006
Last updated
03/17/2008
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