Provider Demographics
NPI:1568426427
Name:ARDELT, AGNIESZKA ANNA (MD)
Entity Type:Individual
Prefix:
First Name:AGNIESZKA
Middle Name:ANNA
Last Name:ARDELT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AGNIESZKA
Other - Middle Name:ANNA
Other - Last Name:ARDELT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2500 METROHEALTH DR
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-1900
Mailing Address - Country:US
Mailing Address - Phone:216-778-7800
Mailing Address - Fax:
Practice Address - Street 1:2500 METROHEALTH DR
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-1900
Practice Address - Country:US
Practice Address - Phone:216-778-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361224852084N0400X, 2084V0102X
OH351322132084N0400X, 2084V0102X, 2084A2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084A2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurocritical Care
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051534611OtherBLUE CROSS
AL009937034Medicaid
AL009937033Medicaid
AL051534612OtherBLUE CROSS
MDH96155Medicare UPIN
AL009937034Medicaid