Unknown Individual – Internal Medicine Physician, NPI 1205813441
Excluded from federal healthcare programs (Medicare/Medicaid)
This provider is listed on the OIG List of Excluded Individuals/Entities (LEIE). Exclusion effective: 2014-03-20. Reason: Conviction of program-related crimes (mandatory; min. 5 years).
Internal Medicine Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Unknown Individual
PO BOX 693
GATES MILLS, OH 440400693
Phone: (216) 346-5353
Fax: (440) 423-1916
Type: Mailing
13241, County Line Road, Chesterland, Chester Township, Geauga County, Ohio, 44026, United States
CHESTERLAND, OH 440262814
Phone: (216) 346-5353
Fax: (440) 423-1916
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
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Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
No Medicare enrollment or revalidation data available for this provider in our database.
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Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
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No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 44040)
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