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8638 Old Troy Pike Suite 103 Huber Heights OH 45424-1051 | |
| (937) 233-5574 | |
| (937) 233-7313 |
| Full Name | |
|---|---|
| Speciality | Internal Medicine |
| Location | 8638 Old Troy Pike, Huber Heights, 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 |
|---|---|
8638 Old Troy Pike Suite 103 Huber Heights OH 45424-1051 Ph: (937) 233-5574 | 8638 Old Troy Pike Suite 103 Huber Heights OH 45424-1051 Ph: (937) 233-5574 |
| NPI Number | 1457304305 |
|---|---|
| Provider Enumeration Date | 05/19/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457304305 | NPI | - | NPPES |
| 0741933 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
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