Healthcare Provider Details

I. General information

NPI: 1467661314
Provider Name (Legal Business Name): ELIJAH ALLEN HOTHEM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 09/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 E TOWN ST SUITE 8900
COLUMBUS OH
43215-4600
US

IV. Provider business mailing address

1481 RAYNE LN
COLUMBUS OH
43220-3127
US

V. Phone/Fax

Practice location:
  • Phone: 614-222-0743
  • Fax:
Mailing address:
  • Phone: 740-502-4752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number57.010321
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: