Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 35123808 | OH |
N | 207PP0204X | Pediatric Emergency Physician | 35123808 | OH |
NPI | 1124260807 |
---|---|
Provider Name | Jennifer Mitzman |
First Address | Columbus, OH 43210-1280 |
Second Address | Columbus, OH 43210-1280 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2009 |
Last Update Date | 10/08/2015 |