Provider Demographics
NPI:1730163288
Name:ELEFF, JODI (DPM)
Entity type:Individual
Prefix:DR
First Name:JODI
Middle Name:
Last Name:ELEFF
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2411 BLOSSOM LN
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-1522
Mailing Address - Country:US
Mailing Address - Phone:216-363-2467
Mailing Address - Fax:
Practice Address - Street 1:2411 BLOSSOM LN
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-1522
Practice Address - Country:US
Practice Address - Phone:216-363-2467
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-002350213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0738698Medicaid
OH0632601Medicare ID - Type Unspecified
OH0738698Medicaid