Provider Demographics
NPI:1326150780
Name:HENNING, JANELLE L (MD)
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:L
Last Name:HENNING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11851 DETROIT AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-3016
Mailing Address - Country:US
Mailing Address - Phone:216-529-7125
Mailing Address - Fax:216-529-7196
Practice Address - Street 1:11851 DETROIT AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-3016
Practice Address - Country:US
Practice Address - Phone:216-529-7125
Practice Address - Fax:216-529-7196
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35087788207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH341542312141OtherCARESOURCE
OH736086OtherBCHP
OH2681325Medicaid
OH351484OtherWELLCARE
OHP00717460OtherRAILROAD CARE
OHP00342586OtherCARERR
OH000000489304OtherANTHEM BC/BS
OH2681325Medicaid
OHI62380Medicare UPIN
OH4194161Medicare PIN