Provider Demographics
NPI:1063723765
Name:PFEFFERLE, KIEL JOHASEN (MD)
Entity type:Individual
Prefix:
First Name:KIEL
Middle Name:JOHASEN
Last Name:PFEFFERLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PARK WEST BLVD
Mailing Address - Street 2:SUITE 330
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-4218
Mailing Address - Country:US
Mailing Address - Phone:330-835-5533
Mailing Address - Fax:
Practice Address - Street 1:1 PARK WEST BLVD
Practice Address - Street 2:SUITE 330
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-4218
Practice Address - Country:US
Practice Address - Phone:330-835-5533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101257861207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC418527Y2VMedicare UPIN