MEDICARE: JODI H CHAPEK PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	50-001032	OH

General Provider Information

NPI Number	:	1447489034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JODI H CHAPEK PA-C

Provider Business Mailing Address
First Line	:	125 E BROAD ST STE 119
Second Line	:
City	:	ELYRIA
State	:	OH
Zip	:	44035-6429
Country	:	US
Telephone Number	:	440-329-7397
Fax Number	:	440-329-7396

Provider Business Practice Location Address
First Line	:	125 E BROAD ST STE 119
Second Line	:
City	:	ELYRIA
State	:	OH
Zip	:	44035-6429
Country	:	US
Telephone Number	:	440-329-7397
Fax Number	:	440-329-7396

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2009
Last Update Date	:	05/07/2010

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