Provider Demographics
NPI:1851324834
Name:MULUMBA, MATIA (MD)
Entity Type:Individual
Prefix:
First Name:MATIA
Middle Name:
Last Name:MULUMBA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MATIA
Other - Middle Name:
Other - Last Name:MULUMBA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2990 NORTON RD
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-8964
Mailing Address - Country:US
Mailing Address - Phone:614-878-8283
Mailing Address - Fax:
Practice Address - Street 1:5263 NIKE STATION WAY
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-7449
Practice Address - Country:US
Practice Address - Phone:614-876-2100
Practice Address - Fax:614-876-2120
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.085097207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2580443Medicaid
I40754Medicare UPIN