Provider Demographics
NPI:1659386423
Name:COLUMBUS MEDICAL GASTROENTEROLOGY
Entity Type:Organization
Organization Name:COLUMBUS MEDICAL GASTROENTEROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BROGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-486-5207
Mailing Address - Street 1:1211 DUBLIN RD FL 2
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-1091
Mailing Address - Country:US
Mailing Address - Phone:614-486-5207
Mailing Address - Fax:614-481-5812
Practice Address - Street 1:1211 DUBLIN RD FL 2
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-1091
Practice Address - Country:US
Practice Address - Phone:614-486-5207
Practice Address - Fax:614-481-5812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0208859Medicaid
OH0208859Medicaid