Healthcare Provider Details

I. General information

NPI: 1932106986
Provider Name (Legal Business Name): BEMA KWADWO BONSU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2005
Last Update Date: 03/05/2020
Certification Date: 03/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 CHILDRENS DR
COLUMBUS OH
43205-2664
US

IV. Provider business mailing address

700 CHILDRENS DR
COLUMBUS OH
43205-2664
US

V. Phone/Fax

Practice location:
  • Phone: 614-722-4579
  • Fax: 614-722-4565
Mailing address:
  • Phone: 614-722-4579
  • Fax: 614-722-4565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number35075788
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: