Provider Demographics
NPI:1629047535
Name:JESSE, JOAN M (MD)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:M
Last Name:JESSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:M
Other - Last Name:JESSE-MILLUZZI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 71313
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44194-0001
Mailing Address - Country:US
Mailing Address - Phone:440-835-3883
Mailing Address - Fax:440-899-2299
Practice Address - Street 1:850 COLUMBIA RD
Practice Address - Street 2:SUITE #330
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-1493
Practice Address - Country:US
Practice Address - Phone:440-835-3883
Practice Address - Fax:440-899-2299
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35055694J207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0822560Medicaid
OH0822560Medicaid
OH7182791Medicare PIN