Provider Demographics
NPI:1255894754
Name:LITZENBERG, KEVIN THOMAS
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:THOMAS
Last Name:LITZENBERG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:THE OHIO STATE UNIVERSITY WEXNER MEDICAL CENTER
Mailing Address - Street 2:293 W 12TH AVE
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43210
Mailing Address - Country:US
Mailing Address - Phone:614-293-3989
Mailing Address - Fax:614-293-9789
Practice Address - Street 1:THE OHIO STATE UNIVERSITY WEXNER MEDICAL CENTER
Practice Address - Street 2:293 W 12TH AVE
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210
Practice Address - Country:US
Practice Address - Phone:614-293-3989
Practice Address - Fax:614-293-9789
Is Sole Proprietor?:No
Enumeration Date:2019-04-11
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
KY56789207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program