Provider Information for 1437773017
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KEVIN PETERCA LISW
Sex: Male
NPI: 1437773017
Last Updated: 2020-05-30
Certification Date: 2020-05-30
Certification Date: 2020-05-30
Details
| Name | Value | ||||||||
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| NPI | 1437773017 | ||||||||
| Enumeration Date | 2020-05-30 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 11150 W WALNUT RIDGE RD CHESTERLAND, OH 44026-1260 United States Phone: 216-312-3440 | Fax: | ||||||||
| Primary Practice Address | 11150 W WALNUT RIDGE RD CHESTERLAND, OH 44026-1260 United States Phone: 216-312-3440 | Fax: | ||||||||
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