Individual
JON D KANNENSOHN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9000 MENTOR AVE STE 100, MENTOR, OH 44060-4496
(440) 974-4411
(440) 974-4173
Mailing address
24701 EUCLID AVE, EUCLID, OH 44117-1714
(440) 974-4411
(440) 974-4173
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
35078034K
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2197662
—
OH
Enumeration date
09/26/2006
Last updated
08/12/2011
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