Provider Demographics
NPI:1700097565
Name:BOBULA, STEVEN MARK (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:MARK
Last Name:BOBULA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 AFRICA RD STE 320
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-9808
Mailing Address - Country:US
Mailing Address - Phone:614-508-0110
Mailing Address - Fax:614-508-0109
Practice Address - Street 1:625 AFRICA RD STE 320
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082
Practice Address - Country:US
Practice Address - Phone:614-508-0110
Practice Address - Fax:614-508-0109
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35121467207RI0200X
IN01068084A207R00000X, 207RI0200X
OH57009989207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0059774Medicaid
OHH461300Medicare PIN
IN200990270Medicaid