MEDICARE: SANJIV JAYANT GALA 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	2085R0202X	Diagnostic Radiology Physician	35-08-9695-G	OH

General Provider Information

NPI Number	:	1669415022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANJIV JAYANT GALA M.D.

Provider Business Mailing Address
First Line	:	5475 RINGS RD STE 300
Second Line	:
City	:	DUBLIN
State	:	OH
Zip	:	43017-7537
Country	:	US
Telephone Number	:	614-210-1890
Fax Number	:	614-210-1886

Provider Business Practice Location Address
First Line	:	3036 W SYLVANIA AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43613-4128
Country	:	US
Telephone Number	:	419-473-0431
Fax Number	:	419-471-2460

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

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	03/03/2022

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