Provider Demographics
NPI:1689660714
Name:LLERENA, AMELIA V (MD)
Entity type:Individual
Prefix:DR
First Name:AMELIA
Middle Name:V
Last Name:LLERENA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:29099 HEALTH CAMPUS DR
Mailing Address - Street 2:STE 290
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-5200
Mailing Address - Country:US
Mailing Address - Phone:440-835-6120
Mailing Address - Fax:440-892-6631
Practice Address - Street 1:29099 HEALTH CAMPUS DR
Practice Address - Street 2:STE 290
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-5200
Practice Address - Country:US
Practice Address - Phone:440-835-6120
Practice Address - Fax:440-892-6631
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-23
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35046514207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0546127Medicaid
0537662Medicare ID - Type Unspecified
OH0546127Medicaid