Healthcare Provider Details

I. General information

NPI: 1730568049
Provider Name (Legal Business Name): KELLEN GOLDSCHMIDT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2015
Last Update Date: 09/16/2020
Certification Date: 09/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5308 HARROUN RD STE 175
SYLVANIA OH
43560-2190
US

IV. Provider business mailing address

333 N SUMMIT ST FL 7
TOLEDO OH
43604-1531
US

V. Phone/Fax

Practice location:
  • Phone: 419-824-5608
  • Fax: 419-882-3686
Mailing address:
  • Phone: 419-824-5608
  • Fax: 419-882-3686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35137282
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: