Healthcare Provider Details

I. General information

NPI: 1184620015
Provider Name (Legal Business Name): JEANINE S HUTTNER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 03/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 HARROUN RD 304
SYLVANIA OH
43560-2182
US

IV. Provider business mailing address

5300 HARROUN RD 304
SYLVANIA OH
43560-2182
US

V. Phone/Fax

Practice location:
  • Phone: 419-824-1100
  • Fax: 419-824-1778
Mailing address:
  • Phone: 419-824-1100
  • Fax: 419-824-1778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35048574
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: