Basic Information
| Provider Information | |||||||||
| NPI: | 1134156250 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VARLAS | ||||||||
| FirstName: | PANTELHS | ||||||||
| MiddleName: | PETE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 74224 | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441940002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2163836480 | ||||||||
| FaxNumber: | 2163836745 | ||||||||
| Practice Location | |||||||||
| Address1: | 3909 ORANGE PL STE 2100 | ||||||||
| Address2: | |||||||||
| City: | BEACHWOOD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441228400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2163830100 | ||||||||
| FaxNumber: | 2163836481 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2006 | ||||||||
| LastUpdateDate: | 01/31/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35082721 | OH | N | Allopathic & Osteopathic Physicians | Family Medicine | 207P00000X | 35082721V | OH | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2461358 | 05 | FL | MEDICAID |