Individual
DR. JENNIFER ANN MITTLESTEAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
5701 FAR HILLS AVE, DAYTON, OH 45429-2207
(937) 435-6222
Mailing address
5701 FAR HILLS AVE, DAYTON, OH 45429-2207
(937) 435-6222
Taxonomy
Speciality
Code
Description
License number
State
207VX0000X
Obstetrics Physician
Primary
35.125512
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2147224
GROUP MEDICAID
OH
01
—
9271701
GROUP MEDICARE
OH
Enumeration date
03/31/2011
Last updated
07/28/2015
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