=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538749239
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CLINT HANDA DO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/08/2021
-----------------------------------------------------
Last Update Date | 10/04/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7100 GRAPHICS WAY STE 2400
-----------------------------------------------------
City | LEWIS CENTER
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43035-0208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-953-4100
-----------------------------------------------------
Fax | 740-953-4173
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7100 GRAPHICS WAY STE 2400
-----------------------------------------------------
City | LEWIS CENTER
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43035-0208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 34.017412
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------