Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 35075797 | OH |
NPI | 1326098708 |
---|---|
Provider Name | Dr. Marc P. Michalsky |
First Address | Columbus, OH 43205-2664 |
Second Address | Columbus, OH 43205 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 30/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2478975 | (05) | OH |
G21125 | (02) |