Provider Demographics
NPI:1841412525
Name:CLEVELAND BIOLOGICALS INC.
Entity Type:Organization
Organization Name:CLEVELAND BIOLOGICALS INC.
Other - Org Name:CBI LABORATORIES
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARKOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:216-621-6322
Mailing Address - Street 1:2475 EAST 22ND STREET
Mailing Address - Street 2:SUITE 205
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44115
Mailing Address - Country:US
Mailing Address - Phone:216-621-3622
Mailing Address - Fax:216-621-3711
Practice Address - Street 1:2475 EAST 22ND STREET
Practice Address - Street 2:SUITE 205
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115
Practice Address - Country:US
Practice Address - Phone:216-621-3622
Practice Address - Fax:216-621-3711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36D065048291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH19655175OtherCAP NUMBER
OH0594969Medicaid
OH36D065048OtherCLIA LAB NUMBER
OH0594969Medicaid
OH118597Medicare UPIN