Provider Demographics
NPI:1760447619
Name:JANNING, JEFFREY THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:THOMAS
Last Name:JANNING
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:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-341-3383
Mailing Address - Fax:859-578-2013
Practice Address - Street 1:830 THOMAS MORE PKWY
Practice Address - Street 2:SUITE 200 A
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-5102
Practice Address - Country:US
Practice Address - Phone:859-341-3383
Practice Address - Fax:859-578-2013
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY25586208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64255862Medicaid
OH2389464Medicaid
KYH82181Medicare UPIN
KY370007062Medicare PIN
OH2389464Medicaid
KY0364936Medicare PIN