Healthcare Provider Details

I. General information

NPI: 1326436809
Provider Name (Legal Business Name): MOHAMED KUYATEH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2015
Last Update Date: 01/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4730 TATERSALL CT
COLUMBUS OH
43230-6393
US

IV. Provider business mailing address

4730 TATERSALL CT
COLUMBUS OH
43230-6393
US

V. Phone/Fax

Practice location:
  • Phone: 614-717-3695
  • Fax:
Mailing address:
  • Phone: 614-717-3695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number401231
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: