Provider Demographics
NPI:1578318408
Name:GRESHAM, DENZEL T
Entity Type:Individual
Prefix:
First Name:DENZEL
Middle Name:T
Last Name:GRESHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17325 EUCLID AVE STE 3040
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44112-1276
Mailing Address - Country:US
Mailing Address - Phone:216-954-8035
Mailing Address - Fax:
Practice Address - Street 1:17325 EUCLID AVE STE 3040
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44112-1276
Practice Address - Country:US
Practice Address - Phone:216-954-8035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator