Provider Demographics
NPI:1609322395
Name:SURIEL PEGUERO, EMIL (DO)
Entity Type:Individual
Prefix:
First Name:EMIL
Middle Name:
Last Name:SURIEL PEGUERO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 STRINGTOWN RD STE 300
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-3993
Mailing Address - Country:US
Mailing Address - Phone:614-544-0101
Mailing Address - Fax:614-544-0017
Practice Address - Street 1:2030 STRINGTOWN RD STE 300
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-3993
Practice Address - Country:US
Practice Address - Phone:614-544-0101
Practice Address - Fax:614-544-0017
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-31
Last Update Date:2023-04-12
Deactivation Date:2023-03-30
Deactivation Code:
Reactivation Date:2023-04-11
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program