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General NPI Number Information
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NPI Number | 1508050485
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Entity Type | Organization
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Legal Business Name | CENTRAL OHIO SPORTS MEDICINE AND ORTHOPEDICS INCORPORATED
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Dates
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Enumeration Date | 09/04/2007
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Last Update Date | 04/23/2013
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Provider Practice Location Address
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Address Line | 165 N MURRAY HILL RD
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City | COLUMBUS
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State | OH
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Zip | 43228-1585
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Country | US
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Telephone | 614-878-6182
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Fax | 614-878-1922
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Provider Business Mailing Address
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Address Line | 165 N MURRAY HILL RD
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City | COLUMBUS
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State | OH
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Zip | 43228-1585
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Country | US
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Telephone | 614-878-6182
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Fax | 614-878-1922
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KEITH ALAN LADU
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Credential | D.O.
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Telephone | 614-878-6182
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 34005826
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License Number State | OH
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