Basic Information
| Provider Information | |||||||||
| NPI: | 1710911847 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WASELENKO | ||||||||
| FirstName: | JAMIE | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4460 RED BANK RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452272172 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5133214333 | ||||||||
| FaxNumber: | 5132320100 | ||||||||
| Practice Location | |||||||||
| Address1: | 4460 RED BANK RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452272172 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5133214333 | ||||||||
| FaxNumber: | 5132320100 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2006 | ||||||||
| LastUpdateDate: | 07/12/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | 35.090078 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 3330131 | 05 | TN | MEDICAID | 4105974 | 01 | BCBS OF TN | OTHER | 64102809 | 05 | KY | MEDICAID | 2757735 | 05 | OH | MEDICAID |