Healthcare Provider Details

I. General information

NPI: 1053861369
Provider Name (Legal Business Name): MACHUCA MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2016
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8648 OLD TROY PIKE STE A
HUBER HEIGHTS OH
45424-1057
US

IV. Provider business mailing address

8648 OLD TROY PIKE STE A
HUBER HEIGHTS OH
45424-1057
US

V. Phone/Fax

Practice location:
  • Phone: 937-795-1101
  • Fax: 937-795-1120
Mailing address:
  • Phone: 937-795-1101
  • Fax: 937-795-1120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number92123
License Number StateOH

VIII. Authorized Official

Name: DR. JENNIFER LYNN MACHUCA
Title or Position: OWNER/ SOLO PHYSICIAN
Credential: MD
Phone: 937-795-1101