Healthcare Provider Details

I. General information

NPI: 1023008356
Provider Name (Legal Business Name): ANAHI M. ORTIZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 09/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 W BROAD ST
COLUMBUS OH
43204-3783
US

IV. Provider business mailing address

7727 SUDBROOK SQ
NEW ALBANY OH
43054-9688
US

V. Phone/Fax

Practice location:
  • Phone: 614-645-2300
  • Fax:
Mailing address:
  • Phone: 614-939-5675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35063104O
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.063104
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: