Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | E5665 | AR |
N | 111NI0900X | Internist | E5665 | AR |
N | 207RC0200X | Critical Care Medicine | E5665 | AR |
Y | 207RP1001X | Pulmonary Disease | E5665 | AR |
NPI | 1063604064 |
---|---|
Provider Name | Eduardo Mireles-Cabodevila |
First Address | Cleveland, OH 44195-0001 |
Second Address | Cleveland, OH 44195-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2007 |
Last Update Date | 20/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
171121001 | (05) | AR |