Healthcare Provider Details

I. General information

NPI: 1003038415
Provider Name (Legal Business Name): JUNAELO WOMEN'S HEALTH & FERTILITY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 11/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 EVERHARD RD NW
CANTON OH
44718-2408
US

IV. Provider business mailing address

4601 EVERHARD RD NW
CANTON OH
44718-2408
US

V. Phone/Fax

Practice location:
  • Phone: 330-497-9400
  • Fax: 330-497-9406
Mailing address:
  • Phone: 330-497-9400
  • Fax: 330-497-9406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35080282M
License Number StateOH

VIII. Authorized Official

Name: GODWIN IKECHUKWU MENIRU
Title or Position: OWNER
Credential: MD
Phone: 330-497-9400