Healthcare Provider Details

I. General information

NPI: 1962089904
Provider Name (Legal Business Name): SAMUEL O MAKANJUOLA DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 PLAZA PROPERTIES BLVD STE 340
COLUMBUS OH
43219-1530
US

IV. Provider business mailing address

3100 PLAZA PROPERTIES BLVD STE 340
COLUMBUS OH
43219-1530
US

V. Phone/Fax

Practice location:
  • Phone: 614-219-9727
  • Fax: 380-444-3384
Mailing address:
  • Phone: 614-219-9727
  • Fax: 380-444-3384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number36.004138
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number36.004138
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: