Provider Demographics
NPI:1336131093
Name:CHESTERLAND INTERNAL MEDICINE ASSOC INC
Entity Type:Organization
Organization Name:CHESTERLAND INTERNAL MEDICINE ASSOC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-729-9000
Mailing Address - Street 1:8254 MAYFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44026-2593
Mailing Address - Country:US
Mailing Address - Phone:440-729-9000
Mailing Address - Fax:440-729-0519
Practice Address - Street 1:8254 MAYFIELD RD
Practice Address - Street 2:
Practice Address - City:CHESTERLAND
Practice Address - State:OH
Practice Address - Zip Code:44026-2593
Practice Address - Country:US
Practice Address - Phone:440-729-9000
Practice Address - Fax:440-729-0519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2448015Medicaid
OH2448015Medicaid