Healthcare Provider Details

I. General information

NPI: 1659012359
Provider Name (Legal Business Name): ALLEN ENRIQUE SIAPNO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 OLENTANGY RIVER RD STE 3000
COLUMBUS OH
43212-3153
US

IV. Provider business mailing address

915 OLENTANGY RIVER RD STE 3000
COLUMBUS OH
43212-3153
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number57.255487
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: