Provider Demographics
NPI:1962589382
Name:SPIESS, JEFFREY LEWIS (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:LEWIS
Last Name:SPIESS
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 1:300 E 185TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44119-1330
Mailing Address - Country:US
Mailing Address - Phone:216-383-2222
Mailing Address - Fax:216-383-3750
Practice Address - Street 1:300 E 185TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44119-1330
Practice Address - Country:US
Practice Address - Phone:216-383-2222
Practice Address - Fax:216-383-3750
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-047489207RH0003X
OH35.047489207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200267050 AMedicaid
OH0230672Medicaid
OH0666088Medicaid
A17125Medicare UPIN
KS200267050 AMedicaid