Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 35038204 | OH |
NPI | 1962495184 |
---|---|
Provider Name | John R. Kean |
First Address | Columbus, OH 43205-2664 |
Second Address | Columbus, OH 43215-5577 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2005 |
Last Update Date | 30/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0383339 | (05) | OH |
2514292 | BCMH (01) | OH |
4015535 | AETNA (01) | OH |
A77628 | (02) | OH |