Provider Demographics
NPI:1760686398
Name:STORCK, JARED CHRISTOPHER (DO)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:CHRISTOPHER
Last Name:STORCK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28601 CHAGRIN BLVD STE 500
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4562
Mailing Address - Country:US
Mailing Address - Phone:216-561-0312
Mailing Address - Fax:216-561-0113
Practice Address - Street 1:28601 CHAGRIN BLVD STE 500
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:OH
Practice Address - Zip Code:44122-4562
Practice Address - Country:US
Practice Address - Phone:216-561-0312
Practice Address - Fax:216-561-0113
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-009221208600000X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0052994Medicaid
H057932Medicare PIN