Provider Demographics
NPI:1497750137
Name:JUSCHKA, DIRK N (MD)
Entity Type:Individual
Prefix:
First Name:DIRK
Middle Name:N
Last Name:JUSCHKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1460 LUDLOW RD
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-7900
Mailing Address - Country:US
Mailing Address - Phone:937-232-8033
Mailing Address - Fax:
Practice Address - Street 1:1460 LUDLOW RD
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-7900
Practice Address - Country:US
Practice Address - Phone:937-232-8033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-18
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35052815207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0616033Medicaid
OHJU2025801Medicare PIN
OHH004460Medicare UPIN
OH0616033Medicaid