| Jonathan F. Diller, M.d., Inc. | |
|
2575 Hayes Ave Suite 4 Fremont OH 43420-5201 | |
| (419) 332-9978 | |
| (419) 332-7989 |
| Full Name | Jonathan F. Diller, M.d., Inc. |
|---|---|
| Speciality | Family Medicine |
| Location | 2575 Hayes Ave, Fremont, Ohio |
| Authorized Official Name and Position | Jonathan Ford Diller (PRESIDENT) |
| Authorized Official Contact | 4193329978 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jonathan F. Diller, M.d., Inc. 2575 Hayes Ave Suite 4 Fremont OH 43420-5201 Ph: (419) 332-9978 | Jonathan F. Diller, M.d., Inc. 2575 Hayes Ave Suite 4 Fremont OH 43420-5201 Ph: (419) 332-9978 |
| NPI Number | 1184640658 |
|---|---|
| Provider Enumeration Date | 07/15/2006 |
| Last Update Date | 05/28/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184640658 | NPI | - | NPPES |
| 2811407 | Medicaid | OH | |
| 35-045285 | Other | OH | OH MEDICAL LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 35-045285 (Ohio) | Primary |
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