Provider Demographics
NPI:1669694246
Name:MACHUCA, JENNIFER LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYNN
Last Name:MACHUCA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:7371 BRANDT PIKE STE D
Mailing Address - Street 2:
Mailing Address - City:HUBER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:45424-3276
Mailing Address - Country:US
Mailing Address - Phone:937-795-1101
Mailing Address - Fax:937-795-1120
Practice Address - Street 1:7371 BRANDT PIKE STE D
Practice Address - Street 2:
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-3276
Practice Address - Country:US
Practice Address - Phone:937-795-1101
Practice Address - Fax:937-795-1120
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.092123207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0193739Medicaid
OH2893301Medicaid
1053861369OtherGROUP NPI
OHCS1721200145Medicaid