MEDICARE: ALLEGRO MEDICAL ARTS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	202K00000X	Phlebology Physician	3

General Provider Information

NPI Number	:	1194942656
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLEGRO MEDICAL ARTS, LLC

Provider Business Mailing Address
First Line	:	1601 MOTOR INN DR
Second Line	:	SUITE 240
City	:	GIRARD
State	:	OH
Zip	:	44420-2420
Country	:	US
Telephone Number	:	330-759-6750
Fax Number	:	330-759-6755

Provider Business Practice Location Address
First Line	:	4866 WUNNENBERG WAY
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-4863
Country	:	US
Telephone Number	:	513-942-6130
Fax Number	:	513-942-6139

Authorized Official
Title or Position	:	RN
Name	:	KRISTIE ANNE DEPASCALE
Credential	:
Telephone Number	:	330-759-6750

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	08/22/2020

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