Provider Demographics
NPI:1639164148
Name:LLERENA, LUIS A (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:A
Last Name:LLERENA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18099 LORAIN AVE
Mailing Address - Street 2:SUITE 533
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-5610
Mailing Address - Country:US
Mailing Address - Phone:216-251-9000
Mailing Address - Fax:216-251-8760
Practice Address - Street 1:18099 LORAIN AVE
Practice Address - Street 2:SUITE 533
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-5610
Practice Address - Country:US
Practice Address - Phone:216-251-9000
Practice Address - Fax:216-251-8760
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3504206207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000560687OtherANTHEM BC/BS
OH0397011Medicaid
OH0548090Medicaid
OHP00705950OtherRAILROAD CARE
OHP00733580OtherRAILROAD CARE
OH0461962Medicare PIN
OHP00733580OtherRAILROAD CARE
OH7387251Medicare PIN
OH0548090Medicaid