Healthcare Provider Details

I. General information

NPI: 1659385359
Provider Name (Legal Business Name): WILLIAM J PETERSILGE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 01/12/2021
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 AUBURN DR # 210
BEACHWOOD OH
44122-4317
US

IV. Provider business mailing address

24701 EUCLID AVE 3RD FLOOR BILLING SERVICES
EUCLID OH
44117-1714
US

V. Phone/Fax

Practice location:
  • Phone: 216-844-5595
  • Fax: 216-844-5522
Mailing address:
  • Phone: 216-844-5595
  • Fax: 216-844-5522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberBP1984740
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number35-057863
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: