Provider Demographics
NPI:1639115033
Name:GURD, ELIZABETH R
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:R
Last Name:GURD
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:RUTH
Other - Middle Name:K
Other - Last Name:IMRIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6000 W CREEK RD
Mailing Address - Street 2:STE 10
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-2139
Mailing Address - Country:US
Mailing Address - Phone:800-223-2273
Mailing Address - Fax:
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:800-223-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350445471208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0600086Medicaid
OHF13169Medicare UPIN
OH0600086Medicaid