Individual
MARY LYNN KIACZ
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1875 MILLIKIN RD, COLUMBUS, OH 43210-2200
(614) 292-0110
(614) 247-6074
Mailing address
1875 MILLIKIN RD, COLUMBUS, OH 43210-2200
(614) 292-0110
(614) 247-6074
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
35-045382
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0760556
—
OH
Enumeration date
02/14/2006
Last updated
07/08/2007
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