UPI (Provider ID): 12483
Change Report (if Any):

Short Name: SHAKER CLINIC

Long Name 1: SHAKER CLINIC LLC
Long Name 2:

Address 1: 20600 CHAGRIN BLVD
Address 2: SUITE 620

City: SHAKER HEIGHTS
Zip Code: 44122
County: CUYA

Contact: ROXANNE JIVIDEN
Title: VP
Phone: 2167514762
FAX: 2167515894

Vendor: 12483

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 03/30/2012

File Produced: 14JUL2016