MEDICARE: DR. PETER J KOBALKA M.D.

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	207ZN0500X	Neuropathology Physician	35131468	OH
2	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	35131468	OH

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	:	1114243391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER J KOBALKA M.D.

Provider Business Mailing Address
First Line	:	700 ACKERMAN RD STE 570
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43202-1579
Country	:	US
Telephone Number	:	614-293-8375
Fax Number	:	614-293-4715

Provider Business Practice Location Address
First Line	:	410 W 10TH AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43210-1240
Country	:	US
Telephone Number	:	614-293-5905
Fax Number	:	614-293-4715

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2010
Last Update Date	:	07/21/2022

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