Provider Demographics
NPI:1750359089
Name:BRESSLER, MICHAEL RANDOLPH (DO)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:RANDOLPH
Last Name:BRESSLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:M.RANDY
Other - Middle Name:
Other - Last Name:BRESSLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:99 N BRICE RD
Mailing Address - Street 2:STE 120
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-6517
Mailing Address - Country:US
Mailing Address - Phone:614-855-0727
Mailing Address - Fax:614-868-9996
Practice Address - Street 1:99 N BRICE RD
Practice Address - Street 2:STE 120
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-6517
Practice Address - Country:US
Practice Address - Phone:614-855-0727
Practice Address - Fax:614-868-9996
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-11
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34005433B207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0977920Medicaid
OHBR0762101Medicare ID - Type Unspecified
OH0977920Medicaid