| Organization Name: | ST JUDES MEDICAL CLINIC |
| NPI Number: | 1609884592 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | NELIDA R ENRIQUE (PRESIDENT TREASURER) |
| Mailing Address: | 7211 Broadway Cleveland |
| State: | OH US |
| Postal Code: | 44105 |
| Phone Number: | 2162711947 |
| Fax Number: | 2162710106 |
| NPI Enumeration Date: | 08/04/2006 |
| NPI Last Update Date: | 02/22/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 35033404 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |