Provider Demographics
NPI:1467495309
Name:HUGHES, JOHN KELLY (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:KELLY
Last Name:HUGHES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:280 BENEDICT AVE STE A
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:OH
Mailing Address - Zip Code:44857-2374
Mailing Address - Country:US
Mailing Address - Phone:419-668-8110
Mailing Address - Fax:419-660-6996
Practice Address - Street 1:280 BENEDICT AVE STE A
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:OH
Practice Address - Zip Code:44857-2374
Practice Address - Country:US
Practice Address - Phone:419-668-8110
Practice Address - Fax:419-660-6996
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35069158207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2076408Medicaid
OH0866154OtherMEDICARE PTAN