Healthcare Provider Details

I. General information

NPI: 1467386094
Provider Name (Legal Business Name): GEORGE DURISEK III MD, MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 OLENTANGY RIVER RD
COLUMBUS OH
43212-3153
US

IV. Provider business mailing address

915 OLENTANGY RIVER RD
COLUMBUS OH
43212-3153
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-8566
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number57.261123
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: