Basic Information
| Provider Information | |||||||||
| NPI: | 1417046251 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FAILINGER | ||||||||
| FirstName: | ANN | ||||||||
| MiddleName: | LOUISE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13241 RAVENNA ROAD | ||||||||
| Address2: | |||||||||
| City: | CHARDON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4402859166 | ||||||||
| FaxNumber: | 4402851806 | ||||||||
| Practice Location | |||||||||
| Address1: | 13241 RAVENNA ROAD | ||||||||
| Address2: | |||||||||
| City: | CHARDON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4402859166 | ||||||||
| FaxNumber: | 4402851806 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2006 | ||||||||
| LastUpdateDate: | 09/07/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 35079549F | OH | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 2276451 | 05 | OH | MEDICAID |