Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | 35-091986 | OH |
N | 2084N0402X | Child Neurologist | M3010 | TX |
NPI | 1265512669 |
---|---|
Provider Name | Stephen Maricich |
First Address | Euclid, OH 44117-1714 |
Second Address | Cleveland, OH 44106 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 01/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
179389501 | (05) | TX |
2842651 | (05) | OH |
I50234 | (02) |