Healthcare Provider Details

I. General information

NPI: 1821275611
Provider Name (Legal Business Name): RENEE SARTAIN D O LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2008
Last Update Date: 06/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6905 PERIMETER LOOP RD STE 200
DUBLIN OH
43016-9601
US

IV. Provider business mailing address

6905 PERIMETER LOOP RD STE 200
DUBLIN OH
43016-9601
US

V. Phone/Fax

Practice location:
  • Phone: 614-766-2220
  • Fax: 614-799-3023
Mailing address:
  • Phone: 614-766-2220
  • Fax: 614-799-3023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number34003964
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number34003964
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number34003964
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number34003964
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34003964
License Number StateOH

VIII. Authorized Official

Name: MS. DOMINIQUE SARTAIN
Title or Position: MANAGER
Credential:
Phone: 614-766-2220