Healthcare Provider Details

I. General information

NPI: 1235240912
Provider Name (Legal Business Name): SUSAN ELIZABETH DAAB-KRZYKOWSKI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 N JAMES RD
COLUMBUS OH
43219-1834
US

IV. Provider business mailing address

420 N JAMES RD
COLUMBUS OH
43219-1834
US

V. Phone/Fax

Practice location:
  • Phone: 614-257-5200
  • Fax:
Mailing address:
  • Phone: 614-257-5200
  • Fax: 614-257-5386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35075816
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: