Healthcare Provider Details

I. General information

NPI: 1053992354
Provider Name (Legal Business Name): MICHELLE V PFEFFER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2021
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5480 NORQUEST BLVD
AUSTINTOWN OH
44515-1820
US

IV. Provider business mailing address

5480 NORQUEST BLVD
AUSTINTOWN OH
44515-1820
US

V. Phone/Fax

Practice location:
  • Phone: 330-779-0529
  • Fax:
Mailing address:
  • Phone: 330-779-0529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number57.251701
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.150365
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: