Healthcare Provider Details

I. General information

NPI: 1578553517
Provider Name (Legal Business Name): STEPHEN E MARKOVICH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 12/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

697 THOMAS LN
COLUMBUS OH
43214-3931
US

IV. Provider business mailing address

5450 FRANTZ RD SUITE 250
DUBLIN OH
43016-4134
US

V. Phone/Fax

Practice location:
  • Phone: 614-566-5414
  • Fax: 614-566-6842
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35067709
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: