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NPI Code Detail

MEDICARE: JOHN S VENGLARCIK III

MEDICARE: JOHN S VENGLARCIK III
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
12080P0208XPediatric Infectious Diseases Physician350488666OH

General Provider Information

NPI Number : 1558774133
Entity Type Code : Organization
Provider Name (Legal Business Name) : JOHN S VENGLARCIK III
Provider Business Mailing Address
First Line : 819 MCKAY CT STE B3
Second Line :
City : BOARDMAN
State : OH
Zip : 44512-5771
Country : US
Telephone Number : 330-884-3993
Fax Number : 888-439-5935
Provider Business Practice Location Address
First Line : 819 MCKAY CT STE B3
Second Line :
City : BOARDMAN
State : OH
Zip : 44512-5771
Country : US
Telephone Number : 330-884-3993
Fax Number : 330-884-0516
Authorized Official
Title or Position : MANAGER
Name : MARGARET VENGLARCIK
Credential :
Telephone Number : 330-884-3993
Provider Enumeration Date : 06/11/2014
Last Update Date : 03/01/2021

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