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Individual

BRIAN W ONDULICK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DO

Contact information

Practice address
3535 PENTAGON BLVD, SUITE 320, BEAVERCREEK, OH 45431-1705
(937) 490-2270
(937) 490-2272
Mailing address
3535 PENTAGON BLVD, SUITE 320, BEAVERCREEK, OH 45431-1705
(937) 490-2270
(937) 490-2272

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
34-00-7860-O
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2495787
OH
Enumeration date
01/17/2006
Last updated
01/07/2021
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