Provider Demographics
NPI:1225257579
Name:EMMANUEL ELUEZE MD INC
Entity Type:Organization
Organization Name:EMMANUEL ELUEZE MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ELUEZE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-431-1500
Mailing Address - Street 1:4758 RIDGE RD
Mailing Address - Street 2:#161
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44144-3327
Mailing Address - Country:US
Mailing Address - Phone:440-236-8484
Mailing Address - Fax:
Practice Address - Street 1:7963 EUCLID AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44103-4226
Practice Address - Country:US
Practice Address - Phone:216-431-1500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-073719207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2064788Medicaid
OH2064788Medicaid