Individual
PRASANTH PATTISAPU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, MPH
Contact information
Practice address
555 S 18TH ST, COLUMBUS, OH 43205-2654
(614) 722-6200
Mailing address
700 CHILDRENS DR, COLUMBUS, OH 43205-2664
(614) 722-2000
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
35.139893
OH
207YP0228X
Pediatric Otolaryngology Physician
Primary
35.139893
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0407117
—
OH
01
—
H766830
CGS - MEDICARE
OH
Enumeration date
03/25/2014
Last updated
11/19/2024
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