Healthcare Provider Details

I. General information

NPI: 1609089317
Provider Name (Legal Business Name): PHILLIP ARTHUR IMMESOETE II MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 STONECREEK DR S
PICKERINGTON OH
43147-9836
US

IV. Provider business mailing address

7951 SHOAL CREEK BLVD STE 300
AUSTIN TX
78757-7582
US

V. Phone/Fax

Practice location:
  • Phone: 740-653-2500
  • Fax: 740-653-2552
Mailing address:
  • Phone: 512-584-8404
  • Fax: 740-653-2552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number35.090300
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: