Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 35087411 | OH |
NPI | 1063477008 |
---|---|
Provider Name | Michael Todd Mckelvey |
First Address | Gahanna, OH 43230-8708 |
Second Address | Gahanna, OH 43230-8708 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2006 |
Last Update Date | 30/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I63126 | (02) | OH |