Provider Demographics
NPI:1053992354
Name:PFEFFER, MICHELLE V (MD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:V
Last Name:PFEFFER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5480 NORQUEST BLVD
Mailing Address - Street 2:
Mailing Address - City:AUSTINTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-1820
Mailing Address - Country:US
Mailing Address - Phone:330-779-0529
Mailing Address - Fax:
Practice Address - Street 1:5480 NORQUEST BLVD
Practice Address - Street 2:
Practice Address - City:AUSTINTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-1820
Practice Address - Country:US
Practice Address - Phone:330-779-0529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-19
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.251701208000000X
390200000X
OH35.150365208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program