Provider Demographics
NPI:1811000839
Name:CLEVELAND, DAVID (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:CLEVELAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3200 N CENTRAL AVE
Mailing Address - Street 2:9TH FLOOR
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2425
Mailing Address - Country:US
Mailing Address - Phone:602-406-3729
Mailing Address - Fax:602-798-9412
Practice Address - Street 1:500 W THOMAS RD
Practice Address - Street 2:SUITE 500
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4224
Practice Address - Country:US
Practice Address - Phone:602-406-6458
Practice Address - Fax:602-406-6498
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ289212080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ560795Medicaid
AZ79750Medicare ID - Type UnspecifiedMEDICARE #
AZ560795Medicaid