| Customcare Md Llc | |
|
1611 S Green Rd Suite 213 South Euclid OH 44121-4128 | |
| (216) 381-1520 | |
| Not Available |
| Full Name | Customcare Md Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1611 S Green Rd, South Euclid, Ohio |
| Authorized Official Name and Position | Todd William Locke (PARTNER) |
| Authorized Official Contact | 2163811520 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Customcare Md Llc 1611 S Green Rd Suite 213 South Euclid OH 44121-4128 Ph: (216) 381-1520 | Customcare Md Llc 1611 S Green Rd Suite 213 South Euclid OH 44121-4128 Ph: (216) 381-1520 |
| NPI Number | 1093904476 |
|---|---|
| Provider Enumeration Date | 10/22/2007 |
| Last Update Date | 02/18/2008 |
| Medicare PECOS PAC ID | 5092744540 |
|---|---|
| Medicare Enrollment ID | O20050805000171 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093904476 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 52123 (Ohio) | Primary |
| Provider Name | Richard Tomm |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1891891651 PECOS PAC ID: 8628007176 Enrollment ID: I20050809000227 |
| Provider Name | Todd W Locke |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1457447682 PECOS PAC ID: 5193748168 Enrollment ID: I20060105000656 |
| Provider Name | Susan M Flick |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710175179 PECOS PAC ID: 5799843330 Enrollment ID: I20081025000036 |
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