1770480527 NPI number — PAULA LENISE CLEVELAND CLINICAL INTERN

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770480527 NPI number — PAULA LENISE CLEVELAND CLINICAL INTERN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CLEVELAND
Provider First Name:
PAULA
Provider Middle Name:
LENISE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CLINICAL INTERN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770480527
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/23/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1125 N RED OAK CIR UNIT 4
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROUND LAKE BEACH
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60073-4419
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
224-716-4601
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
977 LAKEVIEW PKWY STE 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VERNON HILLS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60061-1444
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
224-513-5633
Provider Business Practice Location Address Fax Number:
224-633-4750
Provider Enumeration Date:
10/23/2026

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: 101YM0800X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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