Individual
DR. JASON JOHN JERISHA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
775 WAUKEGAN RD, SUITE 200, DEERFIELD, IL 60015-4342
(800) 317-0711
(800) 434-7113
Mailing address
232 ARBORS PKWY W, NUMBER 22, FINDLAY, OH 45840-8741
(419) 425-1901
(419) 427-2688
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
36-003416
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000377305
ANTHEM BCBS
OH
01
—
000000543939
ANTHEM BCBS
OH
05
—
2589819
—
OH
Enumeration date
05/11/2006
Last updated
05/09/2008
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