Provider Demographics
NPI:1639133317
Name:OPPENHEIM-KNUDSEN, EUNICE (MD)
Entity Type:Individual
Prefix:
First Name:EUNICE
Middle Name:
Last Name:OPPENHEIM-KNUDSEN
Suffix:
Gender:F
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:614-685-4614
Mailing Address - Fax:614-685-5025
Practice Address - Street 1:6790 PERIMETER DR STE 200
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-8068
Practice Address - Country:US
Practice Address - Phone:614-293-4614
Practice Address - Fax:614-293-5025
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.084994207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2629712Medicaid
OH2629712Medicaid
OHOP4179061Medicare PIN