Provider Demographics
NPI:1437145935
Name:HAIMES, JONATHAN LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:LEE
Last Name:HAIMES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5925 CLEVELAND AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43231
Mailing Address - Country:US
Mailing Address - Phone:614-776-4646
Mailing Address - Fax:614-398-0039
Practice Address - Street 1:5925 CLEVELAND AVE
Practice Address - Street 2:SUITE B
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231
Practice Address - Country:US
Practice Address - Phone:614-776-4646
Practice Address - Fax:614-398-0039
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35066575207VG0400X
OH36.0665752083A0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0259170Medicaid
OH0259170Medicaid
OHG39055Medicare UPIN