MEDICARE: ELIZABETH DIEKROGER MD

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	2080P0006X	Developmental - Behavioral Pediatrics Physician	35.099944	OH

General Provider Information

NPI Number	:	1477724110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH DIEKROGER MD

Provider Business Mailing Address
First Line	:	11100 EUCLID AVENUE
Second Line	:	WALKER BLDG. STE. 3150
City	:	CLEVELAND
State	:	OH
Zip	:	44106-6038
Country	:	US
Telephone Number	:	216-844-3230
Fax Number	:	216-201-5188

Provider Business Practice Location Address
First Line	:	11100 EUCLID AVENUE
Second Line	:	WALKER BLDG. STE. 3150
City	:	CLEVELAND
State	:	OH
Zip	:	44106-6038
Country	:	US
Telephone Number	:	216-844-3230
Fax Number	:	216-201-5188

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2008
Last Update Date	:	11/01/2016

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