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General NPI Number Information
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NPI Number | 1447560479
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Entity Type | Organization
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Legal Business Name | PETE N POOLOS JR MD INC
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Dates
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Enumeration Date | 10/08/2010
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Last Update Date | 11/11/2010
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Provider Practice Location Address
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Address Line | 18099 LORAIN AVE SUITE 204
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City | CLEVELAND
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State | OH
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Zip | 44111-5610
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Country | US
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Telephone | 216-252-0033
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Fax | 216-252-0061
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Provider Business Mailing Address
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Address Line | 18099 LORAIN AVE SUITE 204
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City | CLEVELAND
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State | OH
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Zip | 44111-5610
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Country | US
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Telephone | 216-252-0033
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Fax | 216-252-0061
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PETE N POOLOS JR.
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Credential | MD
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Telephone | 216-252-0033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | 35026368
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License Number State | OH
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