Provider Demographics
NPI:1134380868
Name:MICHAEL G MANCUSO MD INC
Entity type:Organization
Organization Name:MICHAEL G MANCUSO MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:MANCUSO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-248-2955
Mailing Address - Street 1:33001 SOLON RD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-2839
Mailing Address - Country:US
Mailing Address - Phone:440-248-2955
Mailing Address - Fax:440-248-5717
Practice Address - Street 1:33001 SOLON RD
Practice Address - Street 2:SUITE 211
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-2839
Practice Address - Country:US
Practice Address - Phone:440-248-2955
Practice Address - Fax:440-248-5717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35043115174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty