Provider Demographics
NPI:1033152152
Name:COLUMBUS, MICHAEL J (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:COLUMBUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4850 RED BANK RD
Mailing Address - Street 2:1 PLASTIC SURGERY PLAZA
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45227-1545
Mailing Address - Country:US
Mailing Address - Phone:513-791-4440
Mailing Address - Fax:513-985-6615
Practice Address - Street 1:4850 RED BANK RD
Practice Address - Street 2:1 PLASTIC SURGERY PLAZA
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45227-1545
Practice Address - Country:US
Practice Address - Phone:513-791-4440
Practice Address - Fax:513-985-6615
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35063197208200000X
KY31944208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
311411704OtherTAX ID
OHO877636Medicaid
240004083OtherMEDICARE RAILROAD
KY64952328Medicaid
KYO328205Medicare ID - Type Unspecified
311411704OtherTAX ID
OHCO0714854Medicare ID - Type Unspecified