Basic Information
Provider Information
NPI: 1932181500
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PULEO
FirstName: MARIO
MiddleName: WILLIAM
NamePrefix:  
NameSuffix: II
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1299 OLENTANGY RIVER RD
Address2: STE 103
City: COLUMBUS
State: OH
PostalCode: 432123135
CountryCode: US
TelephoneNumber: 6145664278
FaxNumber: 6145665424
Practice Location
Address1: 111 S GRANT AVE
Address2: HOSPITAL MEDICAL SERVICES
City: COLUMBUS
State: OH
PostalCode: 432154701
CountryCode: US
TelephoneNumber: 6145668883
FaxNumber: 6145668149
Other Information
ProviderEnumerationDate: 11/18/2005
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: X
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208M00000X35086517OHY Allopathic & Osteopathic PhysiciansHospitalist 

No ID Information.


Home