Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 35.091317 | OH |
N | 111NI0900X | Internist | 35.091317 | OH |
Y | 207RA0401X | Internist - Addiction Medicine | 35.091317 | OH |
NPI | 1619181096 |
---|---|
Provider Name | Dr. Vinayak Shukla |
First Address | Dublin, OH 43016-6102 |
Second Address | Columbus, OH 43215-4602 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2007 |
Last Update Date | 25/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2852828 | (05) | OH |
H129712 | MEDICARE OPG TIN (01) | OH |