Provider Demographics
NPI:1861694234
Name:UNIVERSITY PRIMARY CARE PRACTICES INC
Entity type:Organization
Organization Name:UNIVERSITY PRIMARY CARE PRACTICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, UH CLINICAL NETWORK
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-558-8090
Mailing Address - Street 1:PO BOX 772040
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48277-2040
Mailing Address - Country:US
Mailing Address - Phone:216-383-6090
Mailing Address - Fax:216-383-5371
Practice Address - Street 1:18599 LAKE SHORE BLVD STE 600
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44119
Practice Address - Country:US
Practice Address - Phone:216-383-6090
Practice Address - Fax:216-383-5371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4252080014Medicare NSC
OH9332345Medicare PIN