Organization
TEDROS ANDOM, MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TEDROS ANDOM MD (OWNER)
(937) 323-2690
Entity
Organization
Contact information
Practice address
2624 LEXINGTON AVE, SUITE 340, SPRINGFIELD, OH 45505-2607
(937) 688-1588
Mailing address
2624 LEXINGTON AVE, SUITE 340, SPRINGFIELD, OH 45505-2607
(937) 688-1588
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
35-091693
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2854326
—
OH
Enumeration date
06/24/2008
Last updated
08/05/2010
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