Provider Demographics
NPI:1073836623
Name:JIMENEZ, JUAN ANTONIO (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:ANTONIO
Last Name:JIMENEZ
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18099 LORAIN AVE STE 141
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-5611
Mailing Address - Country:US
Mailing Address - Phone:216-941-0333
Mailing Address - Fax:216-941-5257
Practice Address - Street 1:18099 LORAIN AVE STE 141
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-5611
Practice Address - Country:US
Practice Address - Phone:216-941-0333
Practice Address - Fax:216-941-5257
Is Sole Proprietor?:No
Enumeration Date:2010-03-10
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.129496208800000X, 2088F0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No2088F0040XAllopathic & Osteopathic PhysiciansUrologyUrogynecology and Reconstructive Pelvic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0125785Medicaid