Provider Demographics
NPI:1427056076
Name:JIMERSON, ANDREW (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:JIMERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 210146
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-7146
Mailing Address - Country:US
Mailing Address - Phone:216-721-1805
Mailing Address - Fax:216-721-4257
Practice Address - Street 1:11811 SHAKER BLVD
Practice Address - Street 2:STE. 330
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44120-1931
Practice Address - Country:US
Practice Address - Phone:216-721-1805
Practice Address - Fax:216-721-4257
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-141190J173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000135949OtherANTHEM
OH2183622Medicaid
OH2183622Medicaid
OH9213302Medicare ID - Type Unspecified