Facts
- Status
- A
- Type
- Individual
- Enumeration date
- 2018-06-05
- Last updated
- 2018-06-05
Specialties
Licenses
- License OH
- COND.2018595-SP
Location
- Practice location
- 915 MICHIGAN ST
- City
- SIDNEY OH
- Postal code
- 453652401
- Phone
- 937-498-2311
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.