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Individual

GULAM MUKHDOMI

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
4215 GANTZ RD., GROVE CITY, OH 43123
(614) 539-4425
(614) 539-5400
Mailing address
4215 GANTZ RD., GROVE CITY, OH 43123
(614) 539-4425
(614) 539-5400

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
083053
OH
174400000X
Specialist
Primary
083053

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2437018
OH
Enumeration date
07/01/2006
Last updated
11/20/2018
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