Provider Demographics
NPI:1013395367
Name:STROUD, BERTA LEISY (MD)
Entity Type:Individual
Prefix:
First Name:BERTA
Middle Name:LEISY
Last Name:STROUD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BERTA
Other - Middle Name:LEISY
Other - Last Name:CERRO GOMEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1332
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47402-1332
Mailing Address - Country:US
Mailing Address - Phone:812-345-8188
Mailing Address - Fax:844-338-4526
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-444-0660
Practice Address - Fax:216-444-7360
Is Sole Proprietor?:No
Enumeration Date:2015-05-07
Last Update Date:2020-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program