Provider Demographics
NPI:1447231436
Name:KIETURAKIS, JOLANTA M (MD)
Entity Type:Individual
Prefix:
First Name:JOLANTA
Middle Name:M
Last Name:KIETURAKIS
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:P.O. BOX 632317
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-2317
Mailing Address - Country:US
Mailing Address - Phone:937-208-4380
Mailing Address - Fax:937-208-3843
Practice Address - Street 1:1 WYOMING ST
Practice Address - Street 2:3D FL, ANES. DEPT., ATTN: BARB
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409
Practice Address - Country:US
Practice Address - Phone:937-208-4380
Practice Address - Fax:937-208-3843
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35067407207L00000X
OH35.067407207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0983897Medicaid
OHK10767153Medicare UPIN