Healthcare Provider Details

I. General information

NPI: 1295739282
Provider Name (Legal Business Name): HELMUT J JUNGSCHAFFER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 01/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 W LORAIN ST STE E
OBERLIN OH
44074-1087
US

IV. Provider business mailing address

PO BOX 636643
CINCINNATI OH
45263-6643
US

V. Phone/Fax

Practice location:
  • Phone: 440-774-7337
  • Fax: 440-774-7327
Mailing address:
  • Phone: 440-989-3801
  • Fax: 440-960-0264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35060944
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: