Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 35.121349 | OH |
NPI | 1164717260 |
---|---|
Provider Name | Benjamin Jacob Burkam |
First Address | Dublin, OH 43016-6102 |
Second Address | Columbus, OH 43214-3931 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2011 |
Last Update Date | 25/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0122464 | (05) | OH |