Provider Demographics
NPI:1518979962
Name:JACONO, KARI M (MD)
Entity Type:Individual
Prefix:
First Name:KARI
Middle Name:M
Last Name:JACONO
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:PO BOX 8792
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-8792
Mailing Address - Country:US
Mailing Address - Phone:440-282-7408
Mailing Address - Fax:440-690-2214
Practice Address - Street 1:3600 KOLBE RD STE 120
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-1652
Practice Address - Country:US
Practice Address - Phone:440-282-7408
Practice Address - Fax:440-690-2214
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35084438208000000X
OH35-084438207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2490264Medicaid
OH2490264OtherBCMH
OH2490264OtherBCMH
OH2490264Medicaid