Individual
MR. DOUGLAS TIDWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CCP
Contact information
Practice address
580 LINCOLN PARK BLVD, SUITE 322, KETTERING, OH 45429-3474
(937) 297-6800
(937) 297-6810
Mailing address
580 LINCOLN PARK BLVD, SUITE 322, KETTERING, OH 45429-3474
(937) 297-6800
(937) 297-6810
Taxonomy
Speciality
Code
Description
License number
State
242T00000X
Perfusionist
Primary
—
—
Other
Enumeration date
02/26/2009
Last updated
02/26/2009
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