Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 57.021947 | OH |
NPI | 1063852853 |
---|---|
Provider Name | Dr. Leo Fernando Ditzel Filho |
First Address | Columbus, OH 43210-1240 |
Second Address | Columbus, OH 43210-1240 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2013 |
Last Update Date | 26/06/2013 |