Provider Demographics
NPI:1760414593
Name:BACEVICE, ANN M (MD)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:M
Last Name:BACEVICE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24701 EUCLID AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11100 EUCLID AVENUE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106
Practice Address - Country:US
Practice Address - Phone:216-844-7700
Practice Address - Fax:216-286-6341
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350802642080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1021123120001OtherPA MEDICAID
OH750458OtherBUCKEYE
OH000000527950OtherANTHEM
OH363418OtherWELLCARE
OHP00411237OtherRAILROAD MEDICARE
OH2350263Medicaid
OH000000221286OtherUNISON
OH7515338OtherAETNA
OHBA4208371Medicare PIN
OH7515338OtherAETNA
OH2350263Medicaid