Healthcare Provider Details

I. General information

NPI: 1730299066
Provider Name (Legal Business Name): KIMBERLY BRADSHAW AUSTIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 12/22/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 POLARIS PKWY SUITE 3000
WESTERVILLE OH
43082-7989
US

IV. Provider business mailing address

5450 FRANTZ RD STE 360
DUBLIN OH
43016-4141
US

V. Phone/Fax

Practice location:
  • Phone: 614-533-3354
  • Fax: 614-533-3228
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number84109
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: