Provider Demographics
NPI:1104970805
Name:FAITH MEDICAL ASSOCIATES, INC
Entity type:Organization
Organization Name:FAITH MEDICAL ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MONA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-791-0017
Mailing Address - Street 1:11201 SHAKER BLVD
Mailing Address - Street 2:240
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44104-3869
Mailing Address - Country:US
Mailing Address - Phone:216-791-0017
Mailing Address - Fax:216-791-0021
Practice Address - Street 1:6789 RIDGE RD
Practice Address - Street 2:202
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-5649
Practice Address - Country:US
Practice Address - Phone:440-842-5555
Practice Address - Fax:440-842-5556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35050141207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty