Healthcare Provider Details

I. General information

NPI: 1215911151
Provider Name (Legal Business Name): HILMER O. NEGRETE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 10/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 SOUTHWESTERN RUN
POLAND OH
44514-3688
US

IV. Provider business mailing address

807 SOUTHWESTERN RUN
POLAND OH
44514-3688
US

V. Phone/Fax

Practice location:
  • Phone: 330-729-0059
  • Fax: 330-729-9297
Mailing address:
  • Phone: 330-729-0059
  • Fax: 330-729-9297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number35086900
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: