Provider Demographics
NPI:1053642272
Name:ENGELGAU, DEBRA E (LAC)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:E
Last Name:ENGELGAU
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:DEB
Other - Middle Name:
Other - Last Name:ENGELGAU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:4819 CORDOBA ST
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-8903
Mailing Address - Country:US
Mailing Address - Phone:614-204-0660
Mailing Address - Fax:
Practice Address - Street 1:4819 CORDOBA ST
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-8903
Practice Address - Country:US
Practice Address - Phone:614-204-0660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-28
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH65.000173171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000006871OtherOHIO BWC