| 247 Dct | |
|
3100 E 45th St Ste 511 Cleveland OH 44127-1088 | |
| (773) 817-5928 | |
| Not Available |
| Full Name | 247 Dct |
|---|---|
| Speciality | Clinic/Center |
| Location | 3100 E 45th St Ste 511, Cleveland, Ohio |
| Authorized Official Name and Position | Wajahatuddin Macci (PRESIDENT) |
| Authorized Official Contact | 7738175928 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| 247 Dct 343 N Wood Dale Rd Ste 201 Wood Dale IL 60191-1565 Ph: (773) 817-5928 | 247 Dct 3100 E 45th St Ste 511 Cleveland OH 44127-1088 Ph: (773) 817-5928 |
| NPI Number | 1649981887 |
|---|---|
| Provider Enumeration Date | 12/08/2022 |
| Last Update Date | 01/12/2023 |
| Certification Date | 01/12/2023 |
| Medicare PECOS PAC ID | 7719359199 |
|---|---|
| Medicare Enrollment ID | O20230213000531 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649981887 | NPI | - | NPPES |
| Provider Name | Tiffany R White |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720348394 PECOS PAC ID: 6406075753 Enrollment ID: I20140918000581 |
| Provider Name | William Defelice |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770700775 PECOS PAC ID: 9931405453 Enrollment ID: I20160309002516 |
| Provider Name | Mary Brooks |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1346754215 PECOS PAC ID: 8426483991 Enrollment ID: I20230615000182 |
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