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General NPI Number Information
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NPI Number | 1770540098
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Entity Type | Organization
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Legal Business Name | HILLCREST DIAGNOSTIC INTERNAL MEDICINE SERVICES
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Dates
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Enumeration Date | 04/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6780 MAYFIELD RD
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City | CLEVELAND
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State | OH
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Zip | 44124
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Country | US
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Telephone | 440-777-6300
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Fax |
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Provider Business Mailing Address
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Address Line | 21755 BROOKPARK ROAD
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City | CLEVELAND
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State | OH
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Zip | 44126
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Country | US
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Telephone | 440-777-6300
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Fax | 440-777-2330
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Authorized Official
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Title or Position | DIRECTOR
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Name | DONALD PENSIERO
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Credential | MD
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Telephone | 440-777-6300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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