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Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
3535 SOUTHERN BLVD, KETTERING, OH 45429-1221
(937) 395-6665
(937) 395-6668
Mailing address
3535 SOUTHERN BLVD, KETTERING, OH 45429-1221
(937) 395-6665
(937) 395-6668

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
34.013794
OH
208M00000X
Hospitalist Physician
Primary
34.013794
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0362622
OH
Enumeration date
03/15/2016
Last updated
03/31/2025
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