Provider Demographics
NPI:1831198621
Name:JUDIS, JEFFREY M (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:M
Last Name:JUDIS
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 1:1 SEAGATE
Mailing Address - Street 2:SUITE 800
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1558
Mailing Address - Country:US
Mailing Address - Phone:567-585-1964
Mailing Address - Fax:419-824-7359
Practice Address - Street 1:5700 MONROE ST
Practice Address - Street 2:SUITE 202
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2767
Practice Address - Country:US
Practice Address - Phone:419-473-6622
Practice Address - Fax:419-473-6627
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35063744207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH01956OtherPARAMOUNT
OH000000188006OtherANTHEM
OH0137382Medicaid
OH07-01505OtherUHC
OH4604033OtherAETNA
OH2029049Medicaid
OH160051808OtherRRMC
OH0137382Medicaid
OH07-01505OtherUHC