Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 2080 | OH |
NPI | 1528050952 |
---|---|
Provider Name | Glenn M Winnestaffer |
First Address | Gahanna, OH 43230-3311 |
Second Address | Gahanna, OH 43230-3311 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2005 |
Last Update Date | 03/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0957460 | (05) | OH |
U49134 | (02) | OH |