Provider Demographics
NPI:1710464912
Name:REGENERATIVE MEDICINE OF OHIO LLC
Entity Type:Organization
Organization Name:REGENERATIVE MEDICINE OF OHIO LLC
Other - Org Name:REGENERATIVE MEDICINE OF OHIO LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:STATUTORY AGENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCCLUSKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-884-0083
Mailing Address - Street 1:9257 W SPRAGUE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH ROYALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44133-1208
Mailing Address - Country:US
Mailing Address - Phone:440-884-0083
Mailing Address - Fax:440-884-6864
Practice Address - Street 1:9257 W SPRAGUE RD
Practice Address - Street 2:
Practice Address - City:NORTH ROYALTON
Practice Address - State:OH
Practice Address - Zip Code:44133-1208
Practice Address - Country:US
Practice Address - Phone:440-884-0083
Practice Address - Fax:440-884-6864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-20
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.050134207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH35.050134OtherMEDICAL LICENSE