Provider Demographics
NPI:1689821795
Name:WHOLEKIDS PEDIATRICS, LLC
Entity Type:Organization
Organization Name:WHOLEKIDS PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DHANAWANTI
Authorized Official - Middle Name:
Authorized Official - Last Name:SANT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-596-7301
Mailing Address - Street 1:72 W 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43201-5201
Mailing Address - Country:US
Mailing Address - Phone:614-596-7301
Mailing Address - Fax:614-487-9412
Practice Address - Street 1:72 W 3RD AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43201-5201
Practice Address - Country:US
Practice Address - Phone:614-596-7301
Practice Address - Fax:614-487-9412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-20
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35069473J174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0237630Medicaid