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General NPI Number Information
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NPI Number | 1285780031
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Entity Type | Organization
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Legal Business Name | NEW HORIZON DERMATOLOGY, INC
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 05/02/2008
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Provider Practice Location Address
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Address Line | 6693 N CHESTNUT ST STE 125A
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City | RAVENNA
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State | OH
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Zip | 44266-3900
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Country | US
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Telephone | 330-296-2879
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Fax | 330-296-4656
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Provider Business Mailing Address
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Address Line | 6693 N CHESTNUT ST STE 125A
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City | RAVENNA
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State | OH
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Zip | 44266-3900
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Country | US
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Telephone | 330-296-2879
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Fax | 330-296-4656
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHELLE A JAHNKE
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Credential | M.D.
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Telephone | 330-296-2879
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 35-07-30985
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License Number State | OH
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