Provider Demographics
NPI:1043781941
Name:WESTERN RESERVE MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:WESTERN RESERVE MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-248-6500
Mailing Address - Street 1:30575 BAINBRIDGE RD STE 300
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-2275
Mailing Address - Country:US
Mailing Address - Phone:440-248-6500
Mailing Address - Fax:
Practice Address - Street 1:30575 BAINBRIDGE RD STE 300
Practice Address - Street 2:
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-2275
Practice Address - Country:US
Practice Address - Phone:440-248-6500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty