Provider Demographics
NPI:1922713882
Name:PICKERING, MICHAEL K (CSFA,CST)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:K
Last Name:PICKERING
Suffix:
Gender:M
Credentials:CSFA,CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1636 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43207-1855
Mailing Address - Country:US
Mailing Address - Phone:614-439-3428
Mailing Address - Fax:
Practice Address - Street 1:1020 DENNISON AVE STE 200
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43201-3631
Practice Address - Country:US
Practice Address - Phone:614-618-9018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1285804252Medicaid