Provider Demographics
NPI:1447489034
Name:CHAPEK, JODI H (PA-C)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:H
Last Name:CHAPEK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:AM
Other - Last Name:HARWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:125 E BROAD ST STE 119
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-6429
Mailing Address - Country:US
Mailing Address - Phone:440-329-7397
Mailing Address - Fax:440-329-7396
Practice Address - Street 1:125 E BROAD ST STE 119
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-6429
Practice Address - Country:US
Practice Address - Phone:440-329-7397
Practice Address - Fax:440-329-7396
Is Sole Proprietor?:No
Enumeration Date:2009-07-06
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50-001032363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPA76101Medicare PIN
OHP17009Medicare UPIN