Individual
PAUL F HERGENROEDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
17876 SAINT CLAIR AVE, CLEVELAND, OH 44110
(216) 383-2222
(216) 298-0241
Mailing address
17876 SAINT CLAIR AVE, CLEVELAND, OH 44110-2602
(216) 383-2222
(216) 298-0241
Taxonomy
Speciality
Code
Description
License number
State
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
Primary
35.087486
OH
207RH0003X
Hematology & Oncology Physician
35.087486
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0159
BLUE CROSS
PA
05
—
1010757980001
—
PA
01
—
140052
PA GROUP
PA
Enumeration date
06/21/2005
Last updated
06/26/2019
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