Provider Demographics
NPI:1295739282
Name:JUNGSCHAFFER, HELMUT J (MD)
Entity type:Individual
Prefix:
First Name:HELMUT
Middle Name:J
Last Name:JUNGSCHAFFER
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 636643
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6643
Mailing Address - Country:US
Mailing Address - Phone:440-989-3801
Mailing Address - Fax:440-960-0264
Practice Address - Street 1:224 W LORAIN ST
Practice Address - Street 2:STE E
Practice Address - City:OBERLIN
Practice Address - State:OH
Practice Address - Zip Code:44074-1087
Practice Address - Country:US
Practice Address - Phone:440-774-7337
Practice Address - Fax:440-774-7327
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35060944208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0236248Medicaid
OH0816193Medicaid
OH3025372Medicaid
OH0816193Medicaid
OH9389631Medicare PIN
OH0830433Medicare PIN
OH3025372Medicaid
OH4258441Medicare PIN