Healthcare Provider Details

I. General information

NPI: 1407532286
Provider Name (Legal Business Name): EZGI ATILGAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL DR DCO58.00
COLUMBIA MO
65212
US

IV. Provider business mailing address

1 HOSPITAL DR DCO58.00
COLUMBIA MO
65212
US

V. Phone/Fax

Practice location:
  • Phone: 573-882-4438
  • Fax: 573-884-9992
Mailing address:
  • Phone: 573-882-4438
  • Fax: 573-884-9992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2023018986
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2023018986
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: