Provider Demographics
NPI:1922163161
Name:KRISTIN L OAKS DO INC
Entity Type:Organization
Organization Name:KRISTIN L OAKS DO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:LIESER
Authorized Official - Last Name:OAKS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:614-785-9333
Mailing Address - Street 1:933 HIGH ST STE 116
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-4046
Mailing Address - Country:US
Mailing Address - Phone:614-785-9333
Mailing Address - Fax:614-785-9335
Practice Address - Street 1:933 HIGH ST STE 116
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-4046
Practice Address - Country:US
Practice Address - Phone:614-785-9333
Practice Address - Fax:614-785-9335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-7232-0207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2291256Medicaid
OH000000386699OtherANTHEM
OH2291256Medicaid
OH9358731Medicare PIN