Provider Information for 1285111815
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BENJAMIN SETH LATELLE
Sex: Male
NPI: 1285111815
Last Updated: 2024-11-05
Certification Date: 2024-11-04
Certification Date: 2024-11-04
Details
| Name | Value | ||||||||||||||||||||
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| NPI | 1285111815 | ||||||||||||||||||||
| Enumeration Date | 2018-07-26 | ||||||||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||||||||
| Sole Proprietor | YES | ||||||||||||||||||||
| Status | Active | ||||||||||||||||||||
| Mailing Address | 527 S HIGH ST COLUMBUS, OH 43215-5602 United States Phone: 434-532-5541 | Fax: | ||||||||||||||||||||
| Primary Practice Address | 4000 E MAIN ST COLUMBUS, OH 43213-3593 United States Phone: 888-698-8180 | Fax: | ||||||||||||||||||||
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