Provider Demographics
NPI:1346366671
Name:SERWAH MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:SERWAH MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:TEAH
Authorized Official - Middle Name:
Authorized Official - Last Name:ABASHIDZE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-541-3600
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:440-235-8484
Mailing Address - Fax:440-235-8440
Practice Address - Street 1:1831 FOREST HILLS BLVD
Practice Address - Street 2:#102
Practice Address - City:E CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44112-4348
Practice Address - Country:US
Practice Address - Phone:216-541-3600
Practice Address - Fax:216-541-5528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35083950-A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1336179647OtherNPI
OH2531460Medicaid
OH2531460Medicaid