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Organization

CEDARNILE LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. SAMIR JOSEPH SHAIA DO (PARTNERSHIP)
(330) 567-5600
Entity
Organization

Contact information

Practice address
14805 DETROIT AVE, LAKEWOOD, OH 44107-3934
(330) 576-5600
Mailing address
PO BOX 1243, BATH, OH 44210-1243
(330) 576-5600

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2474979
OH
Enumeration date
01/05/2010
Last updated
01/11/2010
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