Provider Demographics
NPI:1801873997
Name:ZELIS, CYNTHIA (MD)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:ZELIS
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:PO BOX 30551
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44130-0551
Mailing Address - Country:US
Mailing Address - Phone:440-816-6428
Mailing Address - Fax:440-816-6438
Practice Address - Street 1:18181 PEARL RD
Practice Address - Street 2:A206
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44136-6949
Practice Address - Country:US
Practice Address - Phone:440-816-4980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-07-3347-R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH86725OtherQUAL CHOICE
OH000000368592OtherANTHEM
OH2238162Medicaid
OH2123571Medicaid
OHCG4360OtherRAILROAD MEDICARE GROUP
OHP00247248OtherRAILROAD MEDICARE PIN
OHZE0882212Medicare PIN
OHOA9305451Medicare ID - Type UnspecifiedGROUP
OH000000368592OtherANTHEM