Individual
WILEY W SOUBA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
300 W. 10TH AVE, COLUMBUS, OH 43210
(614) 292-2600
Mailing address
700 ACKERMAN ROAD, SUITE 650, COLUMBUS, OH 43202
(614) 261-1141
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
MD069525L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0017644770002
—
PA
Enumeration date
04/25/2006
Last updated
07/08/2007
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