Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 75.000024 | OH |
NPI | 1144854175 |
---|---|
Provider Name | Prof. Michael Patrick Vallely |
First Address | Columbus, OH 43202-1559 |
Second Address | Columbus, OH 43210-1240 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2020 |
Last Update Date | 19/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0393383 | (05) | OH |