Healthcare Provider Details

I. General information

NPI: 1841828621
Provider Name (Legal Business Name): JORDAN SUMMER POGU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2020
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 OLENTANGY RIVER RD
COLUMBUS OH
43214-3908
US

IV. Provider business mailing address

5151 REED RD STE 225C
COLUMBUS OH
43220-2553
US

V. Phone/Fax

Practice location:
  • Phone: 614-884-0641
  • Fax:
Mailing address:
  • Phone: 614-884-0641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35.152211
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number30875
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: