# MINERVA PARK FAMILY PRACTICE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1952548927
- **Authorized official:** DR. OMAR M AWALE MD (MEDICAL DIRECTOR)
- **Authorized official phone:** (614) 428-8105

## Contact information

- **Practice address:** 2330 MORSE RD, SUITE B, COLUMBUS, OH 43229-5801
- **Practice address phone:** (614) 428-8105
- **Mailing address:** PO BOX 29166, COLUMBUS, OH 43229-0166
- **Mailing address phone:** (614) 428-8105
- **Mailing address fax:** (614) 428-8106

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/13/2009
- **Last updated:** 01/13/2009