Provider Demographics
NPI:1134990245
Name:BOUND, DAVID JAMES (BA)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:JAMES
Last Name:BOUND
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6070 MIDDLEBROOK BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKPARK
Mailing Address - State:OH
Mailing Address - Zip Code:44142-3220
Mailing Address - Country:US
Mailing Address - Phone:216-502-5877
Mailing Address - Fax:
Practice Address - Street 1:6161 OAK TREE BLVD
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-2516
Practice Address - Country:US
Practice Address - Phone:216-588-8777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OH171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator