Individual
JEANETTE PORUBOVICH-MIZENKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
55 W WATERLOO RD, AKRON, OH 44319-1116
(330) 724-7715
Mailing address
PO BOX 30076, CLEVELAND, OH 44130-0076
(440) 816-5379
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
35-05-5955-P
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000028998
ANTHEM
OH
05
—
0935420
—
OH
01
—
2228330
AETNA
OH
05
—
2238206
—
OH
01
—
80207
QUAL CHOICE
OH
01
—
CN3937
RAILROAD MEDICARE GROUP
OH
Enumeration date
12/09/2005
Last updated
09/04/2012
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