Healthcare Provider Details

I. General information

NPI: 1346236700
Provider Name (Legal Business Name): NICHOLAS STEVE STEVENS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7750 DILEY RD STE A
CANAL WINCHESTER OH
43110-7758
US

IV. Provider business mailing address

1021 COUNTRY CLUB RD SUITE A
COLUMBUS OH
43213-2470
US

V. Phone/Fax

Practice location:
  • Phone: 614-837-7337
  • Fax: 614-837-7335
Mailing address:
  • Phone: 614-501-7337
  • Fax: 614-434-2701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35075176S
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: