Healthcare Provider Details

I. General information

NPI: 1215472162
Provider Name (Legal Business Name): BALTAZAR ANTONIO ZAVALA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2017
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7171 SAWMILL PKWY
POWELL OH
43065-7828
US

IV. Provider business mailing address

700 ACKERMAN RD STE 2120
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-8714
  • Fax: 614-293-4281
Mailing address:
  • Phone: 614-293-8714
  • Fax: 614-293-4281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number35.154641
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: