Organization
KETTERING INDEPENDENT MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY Y KO (CFO)
(937) 558-3223
Entity
Organization
Contact information
Practice address
4000 MIAMISBURG CENTERVILLE RD, STE. 230, MIAMISBURG, OH 45342-7615
(937) 384-0790
(937) 384-0794
Mailing address
1 PRESTIGE PL STE 550, MIAMISBURG, OH 45342-6115
(937) 762-1310
(937) 522-8068
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
614010103
FECA
OH
Enumeration date
02/23/2011
Last updated
06/13/2023
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