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General NPI Number Information
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NPI Number | 1134932643
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Entity Type | Individual
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Provider Name | SELVIN THEODORE JAYANTH DANIEL EZHILARASU MD
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Gender | Male
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Dates
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Enumeration Date | 01/29/2025
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Last Update Date | 01/29/2025
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Provider Practice Location Address
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Address Line | 700 CHILDRENS DR STE 6B.1
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City | COLUMBUS
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State | OH
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Zip | 43205-2639
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Country | US
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Telephone | 614-483-0900
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Fax |
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Provider Business Mailing Address
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Address Line | 838 E LIVINGSTON AVE
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City | COLUMBUS
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State | OH
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Zip | 43205-2651
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Country | US
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Telephone | 614-483-0900
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2088P0231X
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Taxonomy Name | Pediatric Urology Physician
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License Number | APP000774963
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License Number State | OH
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