Healthcare Provider Details

I. General information

NPI: 1992890461
Provider Name (Legal Business Name): BARIATRIC SPECIALISTS OF OHIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3964 HAMILTON SQUARE BLVD.
GROVEPORT OH
43125-9119
US

IV. Provider business mailing address

3964 HAMILTON SQUARE BLVD.
GROVEPORT OH
43125-9119
US

V. Phone/Fax

Practice location:
  • Phone: 614-834-6980
  • Fax: 614-834-6950
Mailing address:
  • Phone: 614-834-6980
  • Fax: 614-834-6950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFF KAUDERER
Title or Position: DIRECTOR
Credential:
Phone: 614-834-6802