Organization
MAIN STREET FAMILY PRACTICE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARTIN K FUJIMURA MD (PRESIDENT)
(937) 836-5171
Entity
Organization
Contact information
Practice address
9000 NORTH MAIN STREET, SUITE 403, DAYTON, OH 45415-1180
(937) 836-5171
(937) 832-0728
Mailing address
9000 NORTH MAIN STREET, SUITE 403, DAYTON, OH 45415-1180
(937) 836-5171
(937) 832-0728
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00000013156
ANTHEM BCBS
—
05
—
0668433
—
OH
Enumeration date
01/09/2007
Last updated
07/21/2022
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