Healthcare Provider Details

I. General information

NPI: 1083889216
Provider Name (Legal Business Name): MICHELLE MARIE BIRKENHOLZ D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 03/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 FRANTZ RD SUITE 250
DUBLIN OH
43016-4144
US

IV. Provider business mailing address

6714 SWICKARD CT
DUBLIN OH
43016-6094
US

V. Phone/Fax

Practice location:
  • Phone: 614-476-4101
  • Fax:
Mailing address:
  • Phone: 614-439-0876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number34.010414
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: