Provider Demographics
NPI:1932555109
Name:KACZMAREK, JENNIFER (MD, MSC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:KACZMAREK
Suffix:
Gender:F
Credentials:MD, MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1127 EUCLID AVE APT 1003
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44115-1614
Mailing Address - Country:US
Mailing Address - Phone:716-342-4944
Mailing Address - Fax:
Practice Address - Street 1:CLEVELAND CLINIC
Practice Address - Street 2:9500 EUCLID AVENUE/NA-23
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195
Practice Address - Country:US
Practice Address - Phone:216-444-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-06
Last Update Date:2022-08-04
Deactivation Date:2017-01-05
Deactivation Code:
Reactivation Date:2020-04-17
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH35.143862208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program