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General NPI Number Information
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NPI Number | 1457589087
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Entity Type | Individual
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Provider Name | JOHN TYCHONIEVICH MD
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Gender | Male
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Dates
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Enumeration Date | 06/22/2009
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Last Update Date | 11/14/2013
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Provider Practice Location Address
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Address Line | 2222 WELCOME PL
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City | COLUMBUS
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State | OH
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Zip | 43209-7813
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Country | US
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Telephone | 614-533-6800
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Fax | 614-338-8735
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Provider Business Mailing Address
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Address Line | 5350 FRANTZ RD
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City | DUBLIN
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State | OH
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Zip | 43016-4259
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Country | US
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Telephone |
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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 | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | 121624
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License Number State | OH
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