Healthcare Provider Details

I. General information

NPI: 1568492676
Provider Name (Legal Business Name): JOEL R PEERLESS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 12/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 METROHEALTH DR MHMC-SURGERY/TRAUMA/BURN/CRIT CARE
CLEVELAND OH
44109-1900
US

IV. Provider business mailing address

2500 METROHEALTH DR MHMC-SURGERY/TRAUMA/BURN/CRIT CARE
CLEVELAND OH
44109-1900
US

V. Phone/Fax

Practice location:
  • Phone: 216-778-2928
  • Fax:
Mailing address:
  • Phone: 216-778-2928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number34048501
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: