Healthcare Provider Details

I. General information

NPI: 1841661345
Provider Name (Legal Business Name): ALEKSANDR ZAGREBIN NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2015
Last Update Date: 10/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2049 E 100TH ST
CLEVELAND OH
44195-4719
US

IV. Provider business mailing address

1541 PARKWOOD RD
LAKEWOOD OH
44107-4719
US

V. Phone/Fax

Practice location:
  • Phone: 216-482-4906
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberCOA.17466-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: