Provider Demographics
NPI:1497826002
Name:CLEVELAND CLINIC
Entity Type:Organization
Organization Name:CLEVELAND CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR PAIN MANAGEMENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:E
Authorized Official - Last Name:DEWS
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACP
Authorized Official - Phone:440-312-8599
Mailing Address - Street 1:6803 MAYFIELD RD
Mailing Address - Street 2:BUILDING 1 SUITE 200
Mailing Address - City:MAYFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2271
Mailing Address - Country:US
Mailing Address - Phone:440-312-8599
Mailing Address - Fax:
Practice Address - Street 1:6803 MAYFIELD RD
Practice Address - Street 2:BUILDING 1 SUITE 200
Practice Address - City:MAYFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44124-2271
Practice Address - Country:US
Practice Address - Phone:440-312-8599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35061144D174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHBD3178224OtherDEA
OHF28782Medicare UPIN
OHDE0717802Medicare ID - Type Unspecified