=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184053670
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KAREN GADE-PULIDO MD, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/05/2013
-----------------------------------------------------
Last Update Date | 11/05/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1900 S UNION AVE SUITE 100
-----------------------------------------------------
City | ALLIANCE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44601-4355
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-596-6514
-----------------------------------------------------
Fax | 330-596-6517
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 8047
-----------------------------------------------------
City | CANTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44711-8047
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-883-6577
-----------------------------------------------------
Fax | 304-485-4466
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KAREN GADE-PULIDO
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 330-596-6514
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number | 35070357
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------