Provider Demographics
NPI:1295707057
Name:CAO, JUN (MD)
Entity type:Individual
Prefix:
First Name:JUN
Middle Name:
Last Name:CAO
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 1:1 SEAGATE STE 800
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1558
Mailing Address - Country:US
Mailing Address - Phone:419-824-6350
Mailing Address - Fax:419-882-3847
Practice Address - Street 1:5300 HARROUN RD STE 202
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2146
Practice Address - Country:US
Practice Address - Phone:419-824-6350
Practice Address - Fax:419-882-3847
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350822732084N0400X, 2084P0800X
MI43010793832084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4841201Medicaid
OH2386743Medicaid
OH000000 387014OtherANTHEM
OHH79731Medicare UPIN
MI4841201Medicaid
OHP00330851Medicare PIN