MEDICARE: NORTHWEST PEDIATRIC SPECIALISTS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033709100
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWEST PEDIATRIC SPECIALISTS, LLC

Provider Business Mailing Address
First Line	:	700 CHILDRENS DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43205-2664
Country	:	US
Telephone Number	:	614-722-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	2213 CHERRY ST
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43608-2603
Country	:	US
Telephone Number	:	419-251-3232
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	RICHARD MILLER
Credential	:
Telephone Number	:	614-722-4550

Provider Enumeration Date	:	01/22/2021
Last Update Date	:	03/04/2026

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