Provider Demographics
NPI:1053014555
Name:BYNUM, MONROE JR
Entity type:Individual
Prefix:MR
First Name:MONROE
Middle Name:
Last Name:BYNUM
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9633 LAMONTIER AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44104-4737
Mailing Address - Country:US
Mailing Address - Phone:216-513-9961
Mailing Address - Fax:
Practice Address - Street 1:9633 LAMONTIER AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44104-4737
Practice Address - Country:US
Practice Address - Phone:216-513-9961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator