MEDICARE: DR. PAUL STEELE NISWANDER PH.D.

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	231H00000X	Audiologist	A-0153	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0524025	OTHER	OH	BCMH
2	000000208835	OTHER	OH	ANTHEM BLUE CROSS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023220407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL STEELE NISWANDER PH.D.

Provider Business Mailing Address
First Line	:	3006 N HIGH ST STE C
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43202-1145
Country	:	US
Telephone Number	:	614-447-9671
Fax Number	:	614-261-9074

Provider Business Practice Location Address
First Line	:	3006 N HIGH ST STE C
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43202-1145
Country	:	US
Telephone Number	:	614-447-9671
Fax Number	:	614-261-9074

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2007
Last Update Date	:	07/09/2007

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