| Myspecialistmd Network Corporation | |
|
30575 Bainbridge Rd Ste 300 Solon OH 44139-2275 | |
| (216) 800-7137 | |
| Not Available |
| Full Name | Myspecialistmd Network Corporation |
|---|---|
| Speciality | Internal Medicine |
| Location | 30575 Bainbridge Rd Ste 300, Solon, Ohio |
| Authorized Official Name and Position | Jonathan Wiesen (PRESIDENT, CHIEF MEDICAL OFFICER) |
| Authorized Official Contact | 6317599866 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Myspecialistmd Network Corporation 30575 Bainbridge Rd Ste 300 Solon OH 44139-2275 Ph: (216) 762-0777 | Myspecialistmd Network Corporation 30575 Bainbridge Rd Ste 300 Solon OH 44139-2275 Ph: (216) 800-7137 |
| NPI Number | 1598314684 |
|---|---|
| Provider Enumeration Date | 09/10/2019 |
| Last Update Date | 10/26/2022 |
| Medicare PECOS PAC ID | 9638587199 |
|---|---|
| Medicare Enrollment ID | O20210421002212 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598314684 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| 207RC0000X | Internal Medicine - Cardiovascular Disease | (* (Not Available)) | Secondary |
| Provider Name | Jonathan Wiesen |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1912149006 PECOS PAC ID: 1153644786 Enrollment ID: I20150106001254 |
| Provider Name | Hirenkumar Damjighai Italia |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1487815387 PECOS PAC ID: 7012164718 Enrollment ID: I20210421002888 |
| Provider Name | James John Teet |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1740576925 PECOS PAC ID: 8729204730 Enrollment ID: I20210512002160 |
| Provider Name | Frank Suppa |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1700199213 PECOS PAC ID: 5799923199 Enrollment ID: I20211007001223 |
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