Provider Demographics
NPI:1376520353
Name:ZECHIEL, KRISTY A (MD)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:A
Last Name:ZECHIEL
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 1:1250 W NATIONAL RD STE 400
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45315-9506
Mailing Address - Country:US
Mailing Address - Phone:937-836-6000
Mailing Address - Fax:937-832-4805
Practice Address - Street 1:1250 W NATIONAL RD STE 400
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:OH
Practice Address - Zip Code:45315
Practice Address - Country:US
Practice Address - Phone:937-836-6000
Practice Address - Fax:937-832-4805
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.079432207QG0300X
OH35079432207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2522765Medicaid
OHH74986Medicare UPIN
OH2522765Medicaid