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Organization
SYCAMORE PRIMARY CARE GROUP
Active
Organization
SYCAMORE PRIMARY CARE GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TIMOTHY Y KO (CFO)
(937) 558-3208
Entity
Organization
Contact information
Practice address
2115 LEITER RD, MIAMISBURG, OH 45342-3659
(937) 384-6842
(937) 384-6939
Mailing address
10050 INNOVATION DR, SUITE 200, MIAMISBURG, OH 45342-4931
(937) 558-3208
(937) 558-3247
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0227829
—
OH
01
—
SY9283031
MEDICARE
OH
Enumeration date
05/24/2006
Last updated
10/26/2015
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