Provider Demographics
NPI:1447560479
Name:PETE N POOLOS JR MD INC
Entity Type:Organization
Organization Name:PETE N POOLOS JR MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETE
Authorized Official - Middle Name:N
Authorized Official - Last Name:POOLOS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:216-252-0033
Mailing Address - Street 1:18099 LORAIN AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-5610
Mailing Address - Country:US
Mailing Address - Phone:216-252-0033
Mailing Address - Fax:216-252-0061
Practice Address - Street 1:18099 LORAIN AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-5610
Practice Address - Country:US
Practice Address - Phone:216-252-0033
Practice Address - Fax:216-252-0061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-08
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35026368207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
POO131013Medicare PIN