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1520 S Main St Ste 3 Dayton OH 45409-2643 | |
| (937) 208-7272 | |
| (937) 208-7270 |
| Full Name | |
|---|---|
| Speciality | Internal Medicine |
| Location | 1520 S Main St Ste 3, Dayton, Ohio |
| Authorized Official Name and Position | Kenneth Prunier (PRESIDENT AND CEO) |
| Authorized Official Contact | 9372088252 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1520 S Main St Ste 3 Dayton OH 45409-2643 Ph: (937) 208-7272 | 1520 S Main St Ste 3 Dayton OH 45409-2643 Ph: (937) 208-7272 |
| NPI Number | 1659401578 |
|---|---|
| Provider Enumeration Date | 03/07/2007 |
| Last Update Date | 11/06/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659401578 | NPI | - | NPPES |
| 0112390 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
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