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Organization
SHILOH FAMILY MEDICINE LLC
Active
Organization
SHILOH FAMILY MEDICINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDWARD CLACK MD (PHYSICIAN)
(937) 277-9371
Entity
Organization
Contact information
Practice address
5900 N MAIN ST STE 3, DAYTON, OH 45415-3198
(937) 277-9371
Mailing address
5900 N MAIN ST STE 3, DAYTON, OH 45415-3198
(937) 277-9371
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000236927
ANTHEM
—
05
—
2353911
—
OH
Enumeration date
09/11/2007
Last updated
01/03/2023
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