Healthcare Provider Details

I. General information

NPI: 1982446555
Provider Name (Legal Business Name): KALEB ANDREW MOKAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2024
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 W 10TH AVE
COLUMBUS OH
43210-1240
US

IV. Provider business mailing address

700 ACKERMAN RD STE 2120
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-8305
  • Fax: 614-685-7108
Mailing address:
  • Phone: 614-293-8305
  • Fax: 614-685-7108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.010652RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: