Provider Demographics
NPI:1770543159
Name:ONDREJKA, JOHN JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JOSEPH
Last Name:ONDREJKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:510 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-1076
Mailing Address - Country:US
Mailing Address - Phone:440-286-8908
Mailing Address - Fax:440-279-1527
Practice Address - Street 1:7956 TYLER BLVD
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-4806
Practice Address - Country:US
Practice Address - Phone:440-716-1283
Practice Address - Fax:440-716-1605
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-28
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-055148207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH6600162OtherUNITED HEALTHCARE
OH2073581Medicaid
OH80507OtherQUALCHOICE
OH000000339419OtherANTHEM
OH264200000OtherDEPT OF LABOR
OH341425870042OtherMEDICAL MUTUAL OF OHIO
OH264200000OtherFEDERAL BLACK LUNG
OH2073581Medicaid
OH80507OtherQUALCHOICE