Provider Demographics
NPI:1467491860
Name:UNIVERSITY NEUROLOGISTS ASSOC
Entity type:Organization
Organization Name:UNIVERSITY NEUROLOGISTS ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:MD
Authorized Official - Last Name:LANDIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-844-3193
Mailing Address - Street 1:11100 EUCLID AVENUE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106
Mailing Address - Country:US
Mailing Address - Phone:216-844-7664
Mailing Address - Fax:216-983-3153
Practice Address - Street 1:12200 FAIRHILL ROAD
Practice Address - Street 2:FAIRHILL CENTER FOR AGING
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44120
Practice Address - Country:US
Practice Address - Phone:216-844-6300
Practice Address - Fax:216-844-6331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35058711L2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0906087Medicaid
OH0906087Medicaid
OHLEO735866Medicare ID - Type Unspecified