Provider Demographics
NPI:1497083828
Name:RAPHAEL HEALTHCARE, LLC
Entity Type:Organization
Organization Name:RAPHAEL HEALTHCARE, LLC
Other - Org Name:RAPHAEL HEALTHCARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MYUNGSOOK
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:614-932-7000
Mailing Address - Street 1:6631 COMMERCE PKWY
Mailing Address - Street 2:SUITE Q
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-3239
Mailing Address - Country:US
Mailing Address - Phone:614-932-7000
Mailing Address - Fax:614-932-7011
Practice Address - Street 1:6631 COMMERCE PKWY
Practice Address - Street 2:SUITE Q
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-3239
Practice Address - Country:US
Practice Address - Phone:614-932-7000
Practice Address - Fax:614-932-7011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-23
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.092833207ZC0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZC0006XAllopathic & Osteopathic PhysiciansPathologyClinical PathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH35.092833OtherOHIO MEDICAL BOARD LICENSE