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Individual

MATTHEW JOSEPH FANOUS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
597 EXECUTIVE CAMPUS DR, WESTERVILLE, OH 43082-8870
(614) 392-3400
Mailing address
700 ACKERMAN RD STE 2120, COLUMBUS, OH 43202-1559
(614) 392-3400

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
NONE ASSIGNED
OH
208100000X
Physical Medicine & Rehabilitation Physician
Primary
35128375
OH

Other

Enumeration date
04/17/2013
Last updated
04/05/2024
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