Provider Demographics
NPI:1487770889
Name:UNIVERSITY HOSPITALS MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:UNIVERSITY HOSPITALS MEDICAL GROUP, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:JOI
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-214-8025
Mailing Address - Street 1:PO BOX 772044
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48277-2044
Mailing Address - Country:US
Mailing Address - Phone:440-732-3923
Mailing Address - Fax:
Practice Address - Street 1:1611 S GREEN RD STE 146
Practice Address - Street 2:
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121-4121
Practice Address - Country:US
Practice Address - Phone:440-732-3923
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2382541Medicaid
OH9329227Medicare PIN