Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 35.099857 | OH |
NPI | 1235166653 |
---|---|
Provider Name | Sylvester Michael Black |
First Address | Columbus, OH 43202-1559 |
Second Address | Columbus, OH 43210-1280 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2006 |
Last Update Date | 11/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0073084 | (05) | OH |