Provider Demographics
NPI:1851408397
Name:SUMERAUER, DIETER WILHELM (MD)
Entity Type:Individual
Prefix:DR
First Name:DIETER
Middle Name:WILHELM
Last Name:SUMERAUER
Suffix:
Gender:M
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:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:440-234-0422
Mailing Address - Fax:440-230-4021
Practice Address - Street 1:18660 BAGLEY RD # 407
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44130-3483
Practice Address - Country:US
Practice Address - Phone:440-234-0422
Practice Address - Fax:440-230-4021
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-076276208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2167113Medicaid
OHPA9304401Medicare ID - Type Unspecified
OHH15237Medicare UPIN