Provider Demographics
NPI:1093237802
Name:CLE MEDICAL & REHABILITATION LLC
Entity Type:Organization
Organization Name:CLE MEDICAL & REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORG
Authorized Official - Middle Name:
Authorized Official - Last Name:ABAKUMOV
Authorized Official - Suffix:
Authorized Official - Credentials:ESQ
Authorized Official - Phone:216-621-5275
Mailing Address - Street 1:1701 E 12TH STREET
Mailing Address - Street 2:WG 240
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44114
Mailing Address - Country:US
Mailing Address - Phone:216-621-5275
Mailing Address - Fax:216-621-6711
Practice Address - Street 1:1701 E 12TH STREET
Practice Address - Street 2:WG 240
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44114
Practice Address - Country:US
Practice Address - Phone:216-621-5275
Practice Address - Fax:216-621-6711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-13
Last Update Date:2017-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty