Provider Demographics
NPI:1497792584
Name:ENGEL, JEREMY D (MD)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:D
Last Name:ENGEL
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 1:1001 BELLEFONTAINE AVE
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45804-2800
Mailing Address - Country:US
Mailing Address - Phone:419-228-3335
Mailing Address - Fax:
Practice Address - Street 1:602 W REDSKIN TRL
Practice Address - Street 2:
Practice Address - City:WAPAKONETA
Practice Address - State:OH
Practice Address - Zip Code:45895-9349
Practice Address - Country:US
Practice Address - Phone:419-738-5151
Practice Address - Fax:419-941-1092
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35995207Q00000X
OH35.076158207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2270484Medicaid
KY080159288OtherRAILROAD MEDICARE
KY64013303Medicaid
KYP00839905OtherRAILROAD MEDICARE
KY64013303Medicaid
KYP00839905OtherRAILROAD MEDICARE
KY008580024Medicare PIN