Healthcare Provider Details

I. General information

NPI: 1730122557
Provider Name (Legal Business Name): LISA M KEDER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 02/23/2021
Certification Date: 02/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 W WILSON BRIDGE RD STE 2101
WORTHINGTON OH
43085-2688
US

IV. Provider business mailing address

700 ACKERMAN RD STE 2120
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-3069
  • Fax: 614-685-0256
Mailing address:
  • Phone: 614-293-3069
  • Fax: 614-685-0256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35069022
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: