Provider Demographics
NPI:1346690286
Name:MICHAEL G. SARIBALAS D.O.
Entity Type:Organization
Organization Name:MICHAEL G. SARIBALAS D.O.
Other - Org Name:SARIBALAS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SARIBALAS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:614-745-8905
Mailing Address - Street 1:4030 EASTON STA STE 240
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-7012
Mailing Address - Country:US
Mailing Address - Phone:614-532-5232
Mailing Address - Fax:614-532-5734
Practice Address - Street 1:4030 EASTON STA STE 240
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-7012
Practice Address - Country:US
Practice Address - Phone:614-532-5232
Practice Address - Fax:614-532-5734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5858332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2149142Medicaid