Healthcare Provider Details

I. General information

NPI: 1063723765
Provider Name (Legal Business Name): KIEL JOHASEN PFEFFERLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2010
Last Update Date: 01/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PARK WEST BLVD SUITE 330
AKRON OH
44320-4218
US

IV. Provider business mailing address

1 PARK WEST BLVD SUITE 330
AKRON OH
44320-4218
US

V. Phone/Fax

Practice location:
  • Phone: 330-835-5533
  • Fax:
Mailing address:
  • Phone: 330-835-5533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number0101257861
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: