Basic Information
| Provider Information | |||||||||
| NPI: | 1376639302 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOFF | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | ANDREW | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 CHILDREN'S DRIVE | ||||||||
| Address2: | ED. BLDG. 3RD FLOOR | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432052664 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6147224823 | ||||||||
| FaxNumber: | 6147224823 | ||||||||
| Practice Location | |||||||||
| Address1: | 555 S 18TH ST | ||||||||
| Address2: | SUITE 6D | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432052654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6147223114 | ||||||||
| FaxNumber: | 6147223122 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2006 | ||||||||
| LastUpdateDate: | 01/04/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2088P0231X | 36-047763 | OH | Y | Allopathic & Osteopathic Physicians | Urology | Pediatric Urology |
ID Information
| ID | Type | State | Issuer | Description | 0436700 | 05 | OH | MEDICAID |