Provider Demographics
NPI:1235166653
Name:BLACK, SYLVESTER MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:SYLVESTER
Middle Name:MICHAEL
Last Name:BLACK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-6724
Mailing Address - Fax:614-293-4541
Practice Address - Street 1:300 W 10TH AVE
Practice Address - Street 2:11TH FLOOR
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1280
Practice Address - Country:US
Practice Address - Phone:614-293-6724
Practice Address - Fax:614-293-6710
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.099857204F00000X
MN48247208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0073084Medicaid
OHH135271OtherCGS - MEDICARE - NCH