Basic Information
| Provider Information | |||||||||
| NPI: | 1295739282 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JUNGSCHAFFER | ||||||||
| FirstName: | HELMUT | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 636643 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452636643 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4409893801 | ||||||||
| FaxNumber: | 4409600264 | ||||||||
| Practice Location | |||||||||
| Address1: | 224 W LORAIN ST | ||||||||
| Address2: | STE E | ||||||||
| City: | OBERLIN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440741087 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4407747337 | ||||||||
| FaxNumber: | 4407747327 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2005 | ||||||||
| LastUpdateDate: | 01/28/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 35060944 | OH | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 0236248 | 05 | OH | MEDICAID | 0816193 | 05 | OH | MEDICAID | 3025372 | 05 | OH | MEDICAID |