Provider Demographics
NPI:1104178631
Name:CLEVELAND CARDIOVASCULAR RESEARCH FOUNDATION
Entity Type:Organization
Organization Name:CLEVELAND CARDIOVASCULAR RESEARCH FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EMAD
Authorized Official - Middle Name:M
Authorized Official - Last Name:NUKTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-333-8600
Mailing Address - Street 1:20455 LORAIN RD
Mailing Address - Street 2:#200
Mailing Address - City:FAIRVIEW PARK
Mailing Address - State:OH
Mailing Address - Zip Code:44126-3494
Mailing Address - Country:US
Mailing Address - Phone:440-333-8600
Mailing Address - Fax:216-373-0877
Practice Address - Street 1:20455 LORAIN RD
Practice Address - Street 2:#200
Practice Address - City:FAIRVIEW PARK
Practice Address - State:OH
Practice Address - Zip Code:44126-3494
Practice Address - Country:US
Practice Address - Phone:440-333-8600
Practice Address - Fax:216-373-0877
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEST SIDE CARDIOLOGY ASSOCIATES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-08
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch