Provider Demographics
NPI:1467402388
Name:JERISHA, JASON JOHN (DPM)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:JOHN
Last Name:JERISHA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 ARBORS PKWY W
Mailing Address - Street 2:NUMBER 22
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-8741
Mailing Address - Country:US
Mailing Address - Phone:419-425-1901
Mailing Address - Fax:419-427-2688
Practice Address - Street 1:775 WAUKEGAN RD
Practice Address - Street 2:SUITE 200
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-4342
Practice Address - Country:US
Practice Address - Phone:800-317-0711
Practice Address - Fax:800-434-7113
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-003416213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000543939OtherANTHEM BCBS
OH000000377305OtherANTHEM BCBS
OH2589819Medicaid
OHP00258274Medicare PIN
OHJE4165501Medicare PIN
OHV05926Medicare UPIN
OHP00466343Medicare PIN
OH000000543939OtherANTHEM BCBS