Provider Demographics
NPI:1154499960
Name:AHMANN, MAUREEN E (DO)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:E
Last Name:AHMANN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:676 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44311-1059
Mailing Address - Country:US
Mailing Address - Phone:330-252-1135
Mailing Address - Fax:330-252-1147
Practice Address - Street 1:676 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44311-1059
Practice Address - Country:US
Practice Address - Phone:330-252-1135
Practice Address - Fax:330-252-1147
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.008042208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2437401Medicaid
OH2437401Medicaid