Provider Demographics
NPI:1639461882
Name:DUNKI-JACOBS, ERIK MATTHEW (MD)
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:MATTHEW
Last Name:DUNKI-JACOBS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4685 FOREST AVE STE C
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-3359
Mailing Address - Country:US
Mailing Address - Phone:513-246-7796
Mailing Address - Fax:513-852-8525
Practice Address - Street 1:379 DIXMYTH AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45220-2475
Practice Address - Country:US
Practice Address - Phone:513-246-7000
Practice Address - Fax:513-246-7590
Is Sole Proprietor?:No
Enumeration Date:2011-05-06
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.1213952086X0206X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH35.121395OtherOHIO LICENSE
OH0086298Medicaid
OHH210920Medicare PIN