Healthcare Provider Details

I. General information

NPI: 1427912567
Provider Name (Legal Business Name): MIDWEST INTEGRATED CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

775 W BROAD ST STE 260
COLUMBUS OH
43222-1471
US

IV. Provider business mailing address

775 W BROAD ST STE 260
COLUMBUS OH
43222-1471
US

V. Phone/Fax

Practice location:
  • Phone: 614-289-8492
  • Fax:
Mailing address:
  • Phone: 614-289-8492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BRIAN DEAN
Title or Position: ADMIN
Credential:
Phone: 614-762-5206