Individual
DR. THEODORE RAYMOND PACHECO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3600 KOLBE RD, SUITE 127, LORAIN, OH 44053-1654
(440) 414-9200
(216) 201-5582
Mailing address
3600 KOLBE RD, SUITE 127, LORAIN, OH 44053-1654
(440) 414-9200
(216) 201-5582
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
35065306
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000128727
ANTHEM
OH
01
—
060023253
RAILROAD MEDICARE
—
05
—
0972863
—
OH
01
—
100399
KAISER
OH
01
—
341221800068
CARESOURCE
OH
01
—
E65306
SUMMACARE
OH
Enumeration date
01/16/2006
Last updated
01/07/2021
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