Basic Information
| Provider Information | |||||||||
| NPI: | 1841254372 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHEVALIER | ||||||||
| FirstName: | LAURIE | ||||||||
| MiddleName: | MIZER | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1144 DUBLIN RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432151039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142340200 | ||||||||
| FaxNumber: | 6142340201 | ||||||||
| Practice Location | |||||||||
| Address1: | 1144 DUBLIN RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432151039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142340200 | ||||||||
| FaxNumber: | 6142340201 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2006 | ||||||||
| LastUpdateDate: | 04/06/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 04/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 35083045 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00342705 | 01 | OH | RAILROAD MEDICARE PIN | OTHER | 2477387 | 05 | OH | MEDICAID |