Provider Demographics
NPI:1194781906
Name:SANGREE, JILL A (MD)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:A
Last Name:SANGREE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2054 SOUTH GREEN ROAD
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121
Mailing Address - Country:US
Mailing Address - Phone:216-291-9210
Mailing Address - Fax:216-291-9422
Practice Address - Street 1:2054 SOUTH GREEN ROAD
Practice Address - Street 2:
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121
Practice Address - Country:US
Practice Address - Phone:216-291-9210
Practice Address - Fax:216-291-9422
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35083054208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2541002Medicaid