Provider Demographics
NPI:1003038415
Name:JUNAELO WOMEN'S HEALTH & FERTILITY CENTER
Entity Type:Organization
Organization Name:JUNAELO WOMEN'S HEALTH & FERTILITY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GODWIN
Authorized Official - Middle Name:IKECHUKWU
Authorized Official - Last Name:MENIRU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-497-9400
Mailing Address - Street 1:4601 EVERHARD RD NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2408
Mailing Address - Country:US
Mailing Address - Phone:330-497-9400
Mailing Address - Fax:330-497-9406
Practice Address - Street 1:4601 EVERHARD RD NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2408
Practice Address - Country:US
Practice Address - Phone:330-497-9400
Practice Address - Fax:330-497-9406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35080282M207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHJU9333671Medicare ID - Type Unspecified