Provider Demographics
NPI:1518963131
Name:JIMENEZ-MEDINA, EVELYN ESTHER (MD)
Entity Type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:ESTHER
Last Name:JIMENEZ-MEDINA
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 1:658 W MARKET ST
Mailing Address - Street 2:STE 117
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-4697
Mailing Address - Country:US
Mailing Address - Phone:419-222-3482
Mailing Address - Fax:
Practice Address - Street 1:658 W MARKET ST
Practice Address - Street 2:STE 117
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-4697
Practice Address - Country:US
Practice Address - Phone:419-222-3482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35069085J225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0189326Medicaid
OH1417179730OtherGROUP NPI
OHE13321Medicare UPIN
OH0792171Medicare ID - Type Unspecified