Provider Demographics
NPI:1295958742
Name:SMILOVICH, ELIZABETH FINE (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:FINE
Last Name:SMILOVICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:A
Other - Last Name:FINE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:10701 EAST BLVD
Mailing Address - Street 2:MEDICAL SERVICE 111(W)
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-1702
Mailing Address - Country:US
Mailing Address - Phone:216-791-3800
Mailing Address - Fax:216-421-3027
Practice Address - Street 1:10701 EAST BLVD
Practice Address - Street 2:MEDICAL SERVICE 111(W)
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1702
Practice Address - Country:US
Practice Address - Phone:216-791-3800
Practice Address - Fax:216-421-3027
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH89325207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2949788Medicaid
OHP00802867Medicare PIN
OHFI4271381Medicare PIN