Provider Demographics
NPI:1598899841
Name:JEFFREY MP SIMINOVITCH MD INC
Entity Type:Organization
Organization Name:JEFFREY MP SIMINOVITCH MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:MP
Authorized Official - Last Name:SIMINOVITCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-946-4555
Mailing Address - Street 1:9500 MENTOR AVE
Mailing Address - Street 2:SUITE 370
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-8713
Mailing Address - Country:US
Mailing Address - Phone:440-946-4555
Mailing Address - Fax:440-357-5353
Practice Address - Street 1:9500 MENTOR AVE
Practice Address - Street 2:SUITE 370
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-8713
Practice Address - Country:US
Practice Address - Phone:440-946-4555
Practice Address - Fax:440-357-5353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35044819208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0738054Medicaid
OH23781OtherFWJ QUALCHOICE
OH0450695Medicaid
OH298787415001OtherFWJ MEDICAL MUTUAL
OH2410448Medicaid
OH000000133826OtherLHW ANTHEM
OH000000133827OtherJMPS ANTHEM
OHP00005368OtherFWJ RAILROAD
OH000000309743OtherFWJ ANTHEM
OH05084OtherFWJ UNKNOWN
OH340018529OtherLHW RAILROAD
OHCH4740OtherRAILROAD GRP NUMBER
OH1901072OtherFWJ UHC
OH340000044OtherJMPS RAILROAD
OH0738054Medicaid
OH1901072OtherFWJ UHC
OHE29838Medicare UPIN
922243Medicare PIN
OHH80709Medicare UPIN