Basic Information
| Provider Information | |||||||||
| NPI: | 1831198621 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JUDIS | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 SEAGATE | ||||||||
| Address2: | SUITE 800 | ||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436041558 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5675851964 | ||||||||
| FaxNumber: | 4198247359 | ||||||||
| Practice Location | |||||||||
| Address1: | 5700 MONROE ST | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | SYLVANIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435602767 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194736622 | ||||||||
| FaxNumber: | 4194736627 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2005 | ||||||||
| LastUpdateDate: | 08/23/2016 | ||||||||
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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 | 207V00000X | 35063744 | OH | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 2029049 | 05 | OH | MEDICAID | 01956 | 01 | OH | PARAMOUNT | OTHER | 160051808 | 01 | OH | RRMC | OTHER | 4604033 | 01 | OH | AETNA | OTHER | 0137382 | 05 | OH | MEDICAID | 000000188006 | 01 | OH | ANTHEM | OTHER | 07-01505 | 01 | OH | UHC | OTHER |