Basic Information
| Provider Information | |||||||||
| NPI: | 1992704357 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | JAEKLE | ||||||||
| FirstName: | RONALD | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2830 VICTORY PKWY | ||||||||
| Address2: | SUITE 140 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452061785 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5132453335 | ||||||||
| FaxNumber: | 5134757259 | ||||||||
| Practice Location | |||||||||
| Address1: | PERINATAL TREATMENT CENTER | ||||||||
| Address2: | 234 GOODMAN STREET | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452670001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135844800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2005 | ||||||||
| LastUpdateDate: | 07/17/2012 | ||||||||
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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 | 207VM0101X | 35-061570 | OH | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine | 207VM0101X | 29190 | KY | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0850324 | 05 | OH | MEDICAID | 64867203 | 05 | KY | MEDICAID |