Healthcare Provider Details

I. General information

NPI: 1639565401
Provider Name (Legal Business Name): JENNIFER YONKOF MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2015
Last Update Date: 08/24/2020
Certification Date: 08/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6005 MONCLOVA RD STE 230
MAUMEE OH
43537-1800
US

IV. Provider business mailing address

333 N SUMMIT ST FL 7
TOLEDO OH
43604-1531
US

V. Phone/Fax

Practice location:
  • Phone: 419-893-7211
  • Fax: 419-893-8882
Mailing address:
  • Phone: 419-893-7211
  • Fax: 419-893-8882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.133971
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number35.133971
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: