Individual
DR. JAY E SIDLOSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
41201 SCHADDEN RD, SUITE 2, ELYRIA, OH 44035-2220
(440) 324-0401
(440) 324-0405
Mailing address
PO BOX 749495, ATLANTA, GA 30374-9495
(239) 432-8331
(813) 321-1296
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
007091
OH
207RX0202X
Medical Oncology Physician
007091
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000331597
ANTHEM
OH
01
—
05125
KAISER
OH
01
—
1000081
QUAL CHOICE
OH
05
—
2469001
—
OH
01
—
341832420027
CARE SOURCE
OH
01
—
7993540
AETNA
OH
01
—
E07091
SUMMACARE
OH
01
—
P00129474
RAILROAD MEDICARE
OH
Enumeration date
05/18/2006
Last updated
01/10/2023
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