Provider Demographics
NPI:1629030739
Name:JARMOSZUK, IRENE (MD)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:JARMOSZUK
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 1:3600 KOLBE RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-1652
Mailing Address - Country:US
Mailing Address - Phone:440-282-8001
Mailing Address - Fax:440-282-3562
Practice Address - Street 1:3600 KOLBE RD
Practice Address - Street 2:SUITE 206
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-1652
Practice Address - Country:US
Practice Address - Phone:440-282-8001
Practice Address - Fax:440-282-3562
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35066305J207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0161042Medicaid
OH0870342Medicare ID - Type Unspecified
OH0870341Medicare ID - Type Unspecified
E24646Medicare UPIN