Provider Demographics
NPI:1265509053
Name:CLEVELAND UROLOGY ASSOCIATES, INC
Entity Type:Organization
Organization Name:CLEVELAND UROLOGY ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KALISH
Authorized Official - Middle Name:R
Authorized Official - Last Name:KEDIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-891-6500
Mailing Address - Street 1:10500 ANTENUCCI BLVD.
Mailing Address - Street 2:101
Mailing Address - City:GARFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125
Mailing Address - Country:US
Mailing Address - Phone:440-891-6500
Mailing Address - Fax:440-891-1196
Practice Address - Street 1:10500 ANTENUCCI BLVD.
Practice Address - Street 2:101
Practice Address - City:GARFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44125
Practice Address - Country:US
Practice Address - Phone:440-891-6500
Practice Address - Fax:440-891-1196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematologyGroup - Multi-Specialty
No2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
No2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric UrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0964390Medicaid
OH0964390Medicaid