Provider Demographics
NPI:1285859223
Name:EMMANUEL O TUFFUOR
Entity Type:Organization
Organization Name:EMMANUEL O TUFFUOR
Other - Org Name:EMMANUEL O TUFFUOR, MD INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKNIGHT-TUFFUOR
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:216-491-1178
Mailing Address - Street 1:4200 WARRENSVILLE CENTER RD STE 250
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-7000
Mailing Address - Country:US
Mailing Address - Phone:216-491-1178
Mailing Address - Fax:216-491-8486
Practice Address - Street 1:4200 WARRENSVILLE CENTER RD STE 250
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-7000
Practice Address - Country:US
Practice Address - Phone:
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-45260207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHE11514Medicare UPIN
OH0487786Medicare PIN
OH0487781Medicare PIN