Basic Information
| Provider Information | |||||||||
| NPI: | 1578504320 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BESS | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1601 W 5TH AVE | ||||||||
| Address2: | SUITE 137 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432122310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2766799600 | ||||||||
| FaxNumber: | 4232393003 | ||||||||
| Practice Location | |||||||||
| Address1: | 1601 W 5TH AVE | ||||||||
| Address2: | SUITE 137 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432122310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2766799600 | ||||||||
| FaxNumber: | 4232393003 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 207P00000X | 0102050052 | VA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 010288258 | 05 | VA | MEDICAID |