Basic Information
Provider Information | |||||||||
NPI: | 1679004824 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HILTUNEN | ||||||||
FirstName: | AUDREY | ||||||||
MiddleName: | R. | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1405 S HIGH ST | ||||||||
Address2: | OSU/NCH INTERNAL MEDICINE-PEDIATRICS R | ||||||||
City: | COLUMBUS | ||||||||
State: | OH | ||||||||
PostalCode: | 432071043 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6143559000 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 2160 S 1ST AVE # R | ||||||||
Address2: |   | ||||||||
City: | MAYWOOD | ||||||||
State: | IL | ||||||||
PostalCode: | 601533328 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7082169000 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/21/2017 | ||||||||
LastUpdateDate: | 08/12/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 08/12/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 35.141176 | OH | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 208000000X | 036161298 | IL | N |   | Allopathic & Osteopathic Physicians | Pediatrics |   | 208000000X | 35.141176 | OH | N |   | Allopathic & Osteopathic Physicians | Pediatrics |   | 208M00000X | 35.141176 | OH | N |   | Allopathic & Osteopathic Physicians | Hospitalist |   | 207R00000X | 036161298 | IL | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 35.141176 | 01 | OH | OHIO STATE MEDICAL BOARD | OTHER |