Provider Demographics
NPI:1770590028
Name:JUNGLAS, PHILIP DONALD (MD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:DONALD
Last Name:JUNGLAS
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 1:1611 S GREEN RD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-4128
Mailing Address - Country:US
Mailing Address - Phone:216-691-3500
Mailing Address - Fax:216-691-3501
Practice Address - Street 1:1611 S GREEN RD
Practice Address - Street 2:SUITE 160
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121-4128
Practice Address - Country:US
Practice Address - Phone:216-691-3500
Practice Address - Fax:216-691-3501
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35063745207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0116823Medicaid
OHF92743Medicare UPIN
OHJU0773152Medicare ID - Type Unspecified