Healthcare Provider Details

I. General information

NPI: 1376985523
Provider Name (Legal Business Name): MICHAEL FLOR SYPNIAK AT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2013
Last Update Date: 07/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 IRVING SCHOTTENSTEIN DR
COLUMBUS OH
43210-1044
US

IV. Provider business mailing address

692 N HIGH ST APT 301
COLUMBUS OH
43215-1585
US

V. Phone/Fax

Practice location:
  • Phone: 614-292-1164
  • Fax: 614-292-5825
Mailing address:
  • Phone: 585-506-6957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT.002897
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: