Provider Demographics
NPI:1538114343
Name:KAPPUS, JANE C (MD)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:C
Last Name:KAPPUS
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 1:18099 LORAIN AVE
Mailing Address - Street 2:SUITE 429
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-5610
Mailing Address - Country:US
Mailing Address - Phone:216-476-7912
Mailing Address - Fax:216-476-7306
Practice Address - Street 1:18099 LORAIN AVE
Practice Address - Street 2:SUITE 429
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-5610
Practice Address - Country:US
Practice Address - Phone:216-476-7912
Practice Address - Fax:216-476-7306
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35048321207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0540418Medicaid
OHP00739338OtherRAILROAD CARE
OH0537565Medicare PIN
OH7311281Medicare PIN
OHP00739338OtherRAILROAD CARE