Provider Demographics
NPI:1831157841
Name:CAUWENBERGH, JUDE T (DO)
Entity type:Individual
Prefix:
First Name:JUDE
Middle Name:T
Last Name:CAUWENBERGH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2422 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-4985
Mailing Address - Country:US
Mailing Address - Phone:440-992-4422
Mailing Address - Fax:440-997-6507
Practice Address - Street 1:2422 LAKE AVE
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-4985
Practice Address - Country:US
Practice Address - Phone:440-992-4422
Practice Address - Fax:440-997-6507
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006238174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2072644Medicaid
OH2072644Medicaid
OHG78358Medicare UPIN