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General NPI Number Information
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NPI Number | 1295990182
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Entity Type | Organization
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Legal Business Name | KRISTINE HERRMANN PELAGALLI MD INC
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Dates
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Enumeration Date | 07/21/2008
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Last Update Date | 07/21/2008
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Provider Practice Location Address
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Address Line | 1000 W WALLINGS RD STE C
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City | BROADVIEW HTS
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State | OH
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Zip | 44147-1245
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Country | US
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Telephone | 440-717-2000
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Fax | 440-717-2001
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Provider Business Mailing Address
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Address Line | 1000 W WALLINGS RD STE C
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City | BROADVIEW HTS
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State | OH
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Zip | 44147-1245
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Country | US
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Telephone | 440-717-2000
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Fax | 440-717-2001
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MRS. JULIE MARIA BLAIR
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Credential |
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Telephone | 440-371-1287
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 35074513
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License Number State | OH
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