Individual
MICHAEL RICHEY GLEASON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
212 E COLUMBUS AVE STE 3, BELLEFONTAINE, OH 43311-2023
(937) 592-8025
Mailing address
212 E COLUMBUS AVE STE 3, BELLEFONTAINE, OH 43311-2023
(937) 592-8025
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
34003747
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0589706
—
OH
01
—
080008274
RR MEDICARE
OH
01
—
4414286
AETNA INS
OH
Enumeration date
10/27/2006
Last updated
01/14/2010
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