# KETTERING CARD AND VAS SURG

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1881645828
- **Authorized official:** KRISTINE M WILSON CPC, CMPE, CSS (PRACTICE MANAGER)
- **Authorized official phone:** (937) 294-3694

## Contact information

- **Practice address:** 3533 SOUTHERN BLVD, STE 5650, KETTERING, OH 45429-1264
- **Practice address phone:** (937) 294-3611
- **Practice address fax:** (937) 294-9010
- **Mailing address:** 3533 SOUTHERN BLVD, STE 5650, KETTERING, OH 45429-1264
- **Mailing address phone:** (937) 294-3611
- **Mailing address fax:** (937) 294-9010

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | — | NULL | Yes |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/15/2006
- **Last updated:** 12/01/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0639867 | — | OH |