Provider Demographics
NPI:1912908112
Name:CLEVELAND, CYNTHIA (MD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:
Last Name:CLEVELAND
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 1:300 1ST AVE NW
Mailing Address - Street 2:SUITE 230
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-2830
Mailing Address - Country:US
Mailing Address - Phone:507-361-1231
Mailing Address - Fax:507-361-1241
Practice Address - Street 1:300 1ST AVE NW
Practice Address - Street 2:SUITE 230
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-2830
Practice Address - Country:US
Practice Address - Phone:507-361-1231
Practice Address - Fax:507-361-1241
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN31755174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN317207400Medicaid
MNE74127Medicare UPIN
MN317207400Medicaid