Healthcare Provider Details

I. General information

NPI: 1205952926
Provider Name (Legal Business Name): PEDIATRIC PHYICIANS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 03/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3643 RIDGE MILL DR
HILLIARD OH
43026-7752
US

IV. Provider business mailing address

3643 RIDGE MILL DR
HILLIARD OH
43026-7752
US

V. Phone/Fax

Practice location:
  • Phone: 614-771-0200
  • Fax: 614-771-5267
Mailing address:
  • Phone: 614-771-0200
  • Fax: 614-771-5267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.055265
License Number StateOH

VIII. Authorized Official

Name: DR. DANA J SCHULTZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 614-771-0200