Provider Demographics
NPI:1740776764
Name:KURASHVILI, PIMEN
Entity Type:Individual
Prefix:
First Name:PIMEN
Middle Name:
Last Name:KURASHVILI
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 1:2351 E 22ND ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44115-3111
Mailing Address - Country:US
Mailing Address - Phone:216-861-6200
Mailing Address - Fax:216-363-7490
Practice Address - Street 1:2091 LENNOX RD APT 2
Practice Address - Street 2:
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44106-5207
Practice Address - Country:US
Practice Address - Phone:917-444-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-02
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.245978207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine