Provider Demographics
NPI:1780871327
Name:DEOGAONKAR, MILIND S (MD)
Entity type:Individual
Prefix:
First Name:MILIND
Middle Name:S
Last Name:DEOGAONKAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:700 ACKERMAN RD
Mailing Address - Street 2:SUITE 570
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:855-255-0550
Mailing Address - Fax:614-366-4224
Practice Address - Street 1:480 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1229
Practice Address - Country:US
Practice Address - Phone:855-255-0550
Practice Address - Fax:614-366-4224
Is Sole Proprietor?:No
Enumeration Date:2007-09-27
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35090219207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2765084Medicaid
OHH162540Medicare PIN