Basic Information
| Provider Information | |||||||||
| NPI: | 1184620015 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HUTTNER | ||||||||
| FirstName: | JEANINE | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5300 HARROUN RD | ||||||||
| Address2: | 304 | ||||||||
| City: | SYLVANIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435602182 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198241100 | ||||||||
| FaxNumber: | 4198241778 | ||||||||
| Practice Location | |||||||||
| Address1: | 5300 HARROUN RD | ||||||||
| Address2: | 304 | ||||||||
| City: | SYLVANIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435602182 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198241100 | ||||||||
| FaxNumber: | 4198241778 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2005 | ||||||||
| LastUpdateDate: | 03/18/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35048574 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 344428794 | 01 | CA | BEECH STREET | OTHER | 000000142498 | 01 | OH | ANTHEM | OTHER | 6891 | 01 | MI | HEALTH PLAN OF MI | OTHER | 0855025 | 05 | OH | MEDICAID | 4207270 | 01 | OH | AETNA | OTHER | 141887 | 01 | MI | CARE CHOICE | OTHER | 812 | 01 | OH | PARAMOUNT | OTHER | 344428794003 | 01 | OH | HUMANA/TRICARE | OTHER | 4115025 | 05 | MI | MEDICAID | OC03174 | 01 | OH | NATIONWIDE | OTHER | 344428794031 | 01 | OH | CARE SOURCES | OTHER |