Provider Demographics
NPI:1497485320
Name:IOERGER, MICHAEL (MD, PHD, MPH, CSCS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:IOERGER
Suffix:
Gender:M
Credentials:MD, PHD, MPH, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 W MAIN ST UNIT 241
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-9196
Mailing Address - Country:US
Mailing Address - Phone:614-398-1091
Mailing Address - Fax:614-639-8115
Practice Address - Street 1:2231 N HIGH ST STE 205
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43201-1101
Practice Address - Country:US
Practice Address - Phone:614-293-6690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-14
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301510702208D00000X
390200000X
OH35.149610208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program