Healthcare Provider Details

I. General information

NPI: 1700948155
Provider Name (Legal Business Name): POLARIS PARKWAY INTERNAL MEDICINE & PEDIATRICS, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 10/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 POLARIS PKWY SUITE 250
WESTERVILLE OH
43082-8024
US

IV. Provider business mailing address

110 POLARIS PKWY SUITE 250
WESTERVILLE OH
43082-8024
US

V. Phone/Fax

Practice location:
  • Phone: 614-865-4800
  • Fax: 614-865-4900
Mailing address:
  • Phone: 614-865-4800
  • Fax: 614-865-4900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0000X
TaxonomyAdolescent Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. ARRIANN COUNCIL
Title or Position: OFFICE MANAGER
Credential:
Phone: 614-865-4800