Provider Demographics
NPI:1598754293
Name:SIMINOVITCH, JEFFREY M P (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:M P
Last Name:SIMINOVITCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:36060 EUCLID AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-4661
Mailing Address - Country:US
Mailing Address - Phone:440-946-4555
Mailing Address - Fax:440-946-6252
Practice Address - Street 1:36060 EUCLID AVE STE 102
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-4661
Practice Address - Country:US
Practice Address - Phone:440-946-4555
Practice Address - Fax:440-946-6252
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35. 044819208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0450695Medicaid
OH0450695Medicaid
OHA80018Medicare UPIN