| Main Street Family Practice Inc | |
|
9000 North Main Street Suite 403 Dayton OH 45415-1180 | |
| (937) 836-5171 | |
| (937) 832-0728 |
| Full Name | Main Street Family Practice Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 9000 North Main Street, Dayton, Ohio |
| Authorized Official Name and Position | Martin K Fujimura (PRESIDENT) |
| Authorized Official Contact | 9378365171 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Main Street Family Practice Inc 9000 North Main Street Suite 403 Dayton OH 45415-1180 Ph: (937) 836-5171 | Main Street Family Practice Inc 9000 North Main Street Suite 403 Dayton OH 45415-1180 Ph: (937) 836-5171 |
| NPI Number | 1093864035 |
|---|---|
| Provider Enumeration Date | 01/09/2007 |
| Last Update Date | 07/21/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093864035 | NPI | - | NPPES |
| 00000013156 | Other | ANTHEM BCBS | |
| 0668433 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (Ohio) | Primary |
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