MEDICARE: DR. SUSAN ANNE JEKIELEK M.D.

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	207Q00000X	Family Medicine Physician	35069999	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	080145152	OTHER	OH	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922009414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN ANNE JEKIELEK M.D.

Provider Business Mailing Address
First Line	:	4302 ALLEN RD
Second Line	:	SUITE 400
City	:	STOW
State	:	OH
Zip	:	44224-1032
Country	:	US
Telephone Number	:	330-344-3000
Fax Number	:	330-920-6237

Provider Business Practice Location Address
First Line	:	4302 ALLEN RD
Second Line	:	SUITE 400
City	:	STOW
State	:	OH
Zip	:	44224-1032
Country	:	US
Telephone Number	:	330-344-3000
Fax Number	:	330-920-6237

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	02/03/2010

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