Healthcare Provider Details

I. General information

NPI: 1700164993
Provider Name (Legal Business Name): SIDDHARTH UDAY SHETGERI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2011
Last Update Date: 11/19/2021
Certification Date: 11/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 S CLEVELAND AVE
WESTERVILLE OH
43081-1397
US

IV. Provider business mailing address

70 S CLEVELAND AVE
WESTERVILLE OH
43081-1397
US

V. Phone/Fax

Practice location:
  • Phone: 614-890-6555
  • Fax:
Mailing address:
  • Phone: 614-890-6555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number34.013146
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: