Park, Jun Tae

Park, Jun Tae is an individual health care provider with primary practice located at 11100 Euclid Ave , Cleveland OH 44106-1716. He recently has only one registered license in Allopathic & Osteopathic Physicians / Neurology with Special Qualifications in Child Neurology, which is considered as his primary health care specialty. Park, Jun Tae can be contacted via phone (216) 844-7700.

Contact Information

Primary practice address
11100 Euclid Ave Cleveland OH 44106-1716
Phone: (216) 844-7700
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Neurology with Special Qualifications in Child Neurology 2084N0402X 5922577-1205 Utah
Allopathic & Osteopathic Physicians / Neurology with Special Qualifications in Child Neurology 2084N0402X 35-097398 Ohio

Profile Details

NPI number 1437333515
LBN Legal business name Park, Jun Tae
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 24th, 2007
Last updated May 29th, 2013 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1437333515 NPPES
Ohio MEDICAID 0063239

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