Organization
INNOVACARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS C CULLY (PRESIDENT)
(440) 274-5000
Entity
Organization
Contact information
Practice address
5 SEVERANCE CIR, STE 207, CLEVELAND HTS, OH 44118-1566
(216) 382-8874
(216) 382-7166
Mailing address
30701 LORAIN RD STE A, NORTH OLMSTED, OH 44070-6325
(440) 274-5000
(440) 716-8608
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
2375254
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2375254
OHIO LICENSE
OH
Enumeration date
06/01/2015
Last updated
08/10/2015
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