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18697 Bagley Rd Cleveland OH 44130-3497 | |
| (248) 747-0730 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Internal Medicine |
| Location | 18697 Bagley Rd, Cleveland, Ohio |
| Authorized Official Name and Position | Ekundayo Bolaji (MEDICAL DIRECTOR) |
| Authorized Official Contact | 2487470730 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
7212 Boulder Wood Dr Broadview Hts OH 44147-2267 Ph: () - | 18697 Bagley Rd Cleveland OH 44130-3497 Ph: (248) 747-0730 |
| NPI Number | 1295580991 |
|---|---|
| Provider Enumeration Date | 04/17/2024 |
| Last Update Date | 08/28/2024 |
| Medicare PECOS PAC ID | 7719426063 |
|---|---|
| Medicare Enrollment ID | O20240829004205 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295580991 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0300X | Internal Medicine - Geriatric Medicine | (* (Not Available)) | Primary |
| Provider Name | Ekundayo E Bolaji |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1710298609 PECOS PAC ID: 0749436186 Enrollment ID: I20120817000189 |
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