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NPI Code Detail

MEDICARE: KAREN MARIE KRESEVIC PA

MEDICARE: KAREN MARIE KRESEVIC PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant50000890OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15601011774OTHERMIMICHIGAN STATE LICENSE
2085.009974OTHERILILLINOIS STATE LICENSE

General Provider Information

NPI Number : 1881656569
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAREN MARIE KRESEVIC PA
Provider Business Mailing Address
First Line : 10525 BARTHOLOMEW RD
Second Line :
City : CHAGRIN FALLS
State : OH
Zip : 44023-2307
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 29 N ADAMS ST
Second Line :
City : AKRON
State : OH
Zip : 44304-1641
Country : US
Telephone Number : 330-572-7300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2006
Last Update Date : 10/24/2023

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Directions to “ KAREN MARIE KRESEVIC PA” Practice Location

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