MEDICARE: OHIO PLASTIC SURGEONS, INC.

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	174400000X	Specialist

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	:	1952503153
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OHIO PLASTIC SURGEONS, INC.

Provider Business Mailing Address
First Line	:	4661 SAWMILL ROAD
Second Line	:	SUITE 100
City	:	COLUMBUS
State	:	OH
Zip	:	43220-6123
Country	:	US
Telephone Number	:	614-326-4661
Fax Number	:

Provider Business Practice Location Address
First Line	:	4661 SAWMILL RD
Second Line	:	SUITE 100
City	:	COLUMBUS
State	:	OH
Zip	:	43220-6123
Country	:	US
Telephone Number	:	614-326-4661
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. STEVEN L. MONDILLO
Credential	:	MD
Telephone Number	:	614-326-4661

Provider Enumeration Date	:	06/01/2007
Last Update Date	:	08/22/2020

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