Provider Demographics
NPI:1740275684
Name:TESSY MERIDORES MD INC
Entity type:Organization
Organization Name:TESSY MERIDORES MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TESSY
Authorized Official - Middle Name:
Authorized Official - Last Name:MERIDORES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-252-2950
Mailing Address - Street 1:PO BOX 451198
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-0630
Mailing Address - Country:US
Mailing Address - Phone:216-252-2950
Mailing Address - Fax:216-251-8760
Practice Address - Street 1:18099 LORAIN AVE
Practice Address - Street 2:STE 316
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-5610
Practice Address - Country:US
Practice Address - Phone:216-252-2950
Practice Address - Fax:216-251-8760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-16
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35065853207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2857298Medicaid
OH0180745Medicaid
OH0180745Medicaid
OH0769745Medicare ID - Type Unspecified