Provider Demographics
NPI:1932192267
Name:EMILIE ME GURANGO MD PRIMARY CARE INC
Entity Type:Organization
Organization Name:EMILIE ME GURANGO MD PRIMARY CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:GURANGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-743-2100
Mailing Address - Street 1:6681 RIDGE RD
Mailing Address - Street 2:STE 200
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-5713
Mailing Address - Country:US
Mailing Address - Phone:440-743-2100
Mailing Address - Fax:440-743-2101
Practice Address - Street 1:6681 RIDGE RD
Practice Address - Street 2:STE 200
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-5713
Practice Address - Country:US
Practice Address - Phone:440-743-2100
Practice Address - Fax:440-743-2101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35042131208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0463930Medicaid
A80276Medicare UPIN
OH0463930Medicaid