Healthcare Provider Details

I. General information

NPI: 1215428982
Provider Name (Legal Business Name): CALLAN M BIALORUCKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2018
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 W 10TH AVE
COLUMBUS OH
43210-1240
US

IV. Provider business mailing address

26765 CARRONADE DR APT 5107
PERRYSBURG OH
43551-6423
US

V. Phone/Fax

Practice location:
  • Phone: 419-265-2386
  • Fax:
Mailing address:
  • Phone: 419-265-2386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35.143048
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: