Healthcare Provider Details

I. General information

NPI: 1407909385
Provider Name (Legal Business Name): GROVE CITY INTERNAL MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3055 COLUMBUS ST
GROVE CITY OH
43123-2751
US

IV. Provider business mailing address

3055 COLUMBUS ST
GROVE CITY OH
43123-2751
US

V. Phone/Fax

Practice location:
  • Phone: 614-875-9900
  • Fax:
Mailing address:
  • Phone: 614-875-9900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number52244
License Number StateOH

VIII. Authorized Official

Name: DR. DANIEL J WENDORFF
Title or Position: PARTNER
Credential: M.D.
Phone: 614-875-9900