Healthcare Provider Details

I. General information

NPI: 1548262512
Provider Name (Legal Business Name): DAVID M. PEEREBOOM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 12/21/2022
Certification Date: 12/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE R35
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

9500 EUCLID AVE # CA5
CLEVELAND OH
44195-5554
US

V. Phone/Fax

Practice location:
  • Phone: 216-445-6068
  • Fax: 216-444-9464
Mailing address:
  • Phone: 216-308-5554
  • Fax: 216-444-0924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number35-05-7997-P
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number35.057997
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: