| South Dayton Internal Medicine | |
|
6611 Clyo Rd Suite C Centerville OH 45459-2786 | |
| (937) 208-8288 | |
| (937) 208-8286 |
| Full Name | South Dayton Internal Medicine |
|---|---|
| Speciality | Internal Medicine |
| Location | 6611 Clyo Rd, Centerville, Ohio |
| Authorized Official Name and Position | Kenneth Prunier (CEO/PRESIDENT) |
| Authorized Official Contact | 9372088213 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| South Dayton Internal Medicine 6611 Clyo Rd Suite C Centerville OH 45459-2786 Ph: (937) 208-8288 | South Dayton Internal Medicine 6611 Clyo Rd Suite C Centerville OH 45459-2786 Ph: (937) 208-8288 |
| NPI Number | 1174578256 |
|---|---|
| Provider Enumeration Date | 05/24/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174578256 | NPI | - | NPPES |
| 2387279 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
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