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General NPI Number Information
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NPI Number | 1669565578
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Entity Type | Organization
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Legal Business Name | LAKEWOOD PEDIATRICS
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 07/30/2008
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Provider Practice Location Address
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Address Line | 14701 DETROIT AVE SUITE 400
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City | LAKEWOOD
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State | OH
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Zip | 44107-4115
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Country | US
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Telephone | 216-227-1330
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Fax | 216-227-1322
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Provider Business Mailing Address
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Address Line | 14701 DETROIT AVE SUITE 400
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City | LAKEWOOD
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State | OH
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Zip | 44107-4115
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Country | US
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Telephone | 216-227-1330
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Fax | 216-227-1322
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Authorized Official
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Title or Position | D.O./OWNER
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Name | DR. FRED BARRY PEARLMAN
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Credential | D.O.
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Telephone | 216-227-1330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 34004965
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License Number State | OH
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