1639149115 NPI number — DR. EWA M GROSS-SAWICKA MD

Table of content: DR. EWA M GROSS-SAWICKA MD (NPI 1639149115)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639149115 NPI number — DR. EWA M GROSS-SAWICKA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GROSS-SAWICKA
Provider First Name:
EWA
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GROSS
Provider Other First Name:
EWA
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1639149115
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/23/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24701 EUCLID AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EUCLID
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44117-1714
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-250-2070
Provider Business Mailing Address Fax Number:
440-356-1904

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
960 CLAGUE RD STE 3201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESTLAKE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44145-1588
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-250-2070
Provider Business Practice Location Address Fax Number:
440-250-2071
Provider Enumeration Date:
01/25/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  35072612 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2118014 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".