Healthcare Provider Details

I. General information

NPI: 1720222904
Provider Name (Legal Business Name): JAMIE ANNE KISTLER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAMIE GODALE MD

II. Dates (important events)

Enumeration Date: 05/01/2009
Last Update Date: 09/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 MARKET ST
BOARDMAN OH
44512-6725
US

IV. Provider business mailing address

1 PERKINS SQ
AKRON OH
44308-1063
US

V. Phone/Fax

Practice location:
  • Phone: 330-729-7633
  • Fax: 330-729-7656
Mailing address:
  • Phone: 330-729-7633
  • Fax: 330-729-7656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number35.099431
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: