Individual
SOO H. PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5580 TREELINE DR, COLUMBUS, IN 47201-4050
(217) 979-1165
Mailing address
5580 TREELINE DR, COLUMBUS, IN 47201-4050
(217) 979-1165
Taxonomy
Speciality
Code
Description
License number
State
207RI0011X
Interventional Cardiology Physician
Primary
01064126A
IN
207RI0011X
Interventional Cardiology Physician
036042861
IL
207RI0011X
Interventional Cardiology Physician
MD153728
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000984930
ANTHEM PIN
IN
05
—
200031190
—
IN
Enumeration date
06/13/2006
Last updated
07/13/2023
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