Healthcare Provider Details

I. General information

NPI: 1376144469
Provider Name (Legal Business Name): MICHAEL TROMPAK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2020
Last Update Date: 02/23/2022
Certification Date: 02/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 AGLER RD
COLUMBUS OH
43230-2546
US

IV. Provider business mailing address

8663 BATON ROUGE DR
DAYTON OH
45424-1042
US

V. Phone/Fax

Practice location:
  • Phone: 614-284-4114
  • Fax: 614-245-4389
Mailing address:
  • Phone: 440-781-2719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number419642
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRNCNP0029904
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: