MEDICARE: PHYSICIANS OF LONDON INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician
2	207VG0400X	Gynecology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013906312
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICIANS OF LONDON INC.

Provider Business Mailing Address
First Line	:	54 W HIGH ST
Second Line	:	SUITE B
City	:	LONDON
State	:	OH
Zip	:	43140-1075
Country	:	US
Telephone Number	:	740-852-6000
Fax Number	:	740-852-7955

Provider Business Practice Location Address
First Line	:	54 W HIGH ST
Second Line	:	SUITE B
City	:	LONDON
State	:	OH
Zip	:	43140-1075
Country	:	US
Telephone Number	:	740-852-6000
Fax Number	:	740-852-7955

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MITCHELL SPAHN
Credential	:	M.D.
Telephone Number	:	740-852-6000

Provider Enumeration Date	:	10/19/2005
Last Update Date	:	10/08/2009

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