University Plastic Surgeons, Inc.
Organization Active NPI Specialist · Novelty, OH
NPI 1104005776 · NPPES record last updated Feb 4, 2025
Key facts
- NPI
- 1104005776
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Specialist 174400000X
- License
- 35 059617 (OH)
- Legal business name
- UNIVERSITY PLASTIC SURGEONS, INC.
- Practice address
- 13660 Braeburn LN
Novelty, OH 44072-9597 - Phone
- (216) 219-5555
- NPI assigned
- Oct 30, 2007
- Organization subpart
- No
Authorized official
- Name
- Robert T. Stroup, MD
- Title
- Owner
- Phone
- (216) 219-5555
Practitioners 3
-
Brian H. Windle, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120417000583 | OH | Part B Supplier - Clinic/Group Practice | 5597926675 |
Receives reassigned benefits from 1 practitioner Practice locations: Novelty, OH |
National Provider Directory
Locations
13221 Ravenna Rd
Chardon, OH 44024
Phone (440) 286-9421
1611 S Green Rd
Ste 141
South Euclid, OH 44121
Phone (216) 691-4000
1611 S Green Rd
Ste 238
South Euclid, OH 44121
Phone (216) 691-4000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist |
174400000X | 35 059617 | OH | Yes |
Addresses
Primary practice location
13660 Braeburn LN
Novelty, OH 44072-9597
Mailing address
13660 Braeburn LN
Novelty, OH 44072-9597
Phone (216) 219-5555
Other practice location 1
1611 S Green Rd
#238
South Euclid, OH 44121-4128
Phone (216) 691-4000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0879081 | Medicaid | OH | |
| 0801412 | Medicaid | OH |
Other providers in Novelty, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 4, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.