Provider Demographics
NPI:1134179260
Name:GILES, DAUPHINE (MD)
Entity type:Individual
Prefix:
First Name:DAUPHINE
Middle Name:
Last Name:GILES
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 1:4400 RENAISSANCE PKWY
Mailing Address - Street 2:SUITE L
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128-5763
Mailing Address - Country:US
Mailing Address - Phone:216-464-8484
Mailing Address - Fax:216-464-2444
Practice Address - Street 1:4400 RENAISSANCE PKWY
Practice Address - Street 2:SUITE L
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-5763
Practice Address - Country:US
Practice Address - Phone:216-464-8484
Practice Address - Fax:216-464-2444
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350803022085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000229289OtherUNISON
OH000000546693OtherANTHEM
OH746604OtherBUCKEYE
OHP00454336OtherRAILROAD MEDICARE
OH7215711OtherAETNA
OH2348034Medicaid
OH000000546693OtherANTHEM
OHP00454336OtherRAILROAD MEDICARE
H70469Medicare UPIN