Individual
PIAM SHANEHSAZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3535 SOUTHERN BLVD, KETTERING, OH 45429-1221
(937) 395-6665
(937) 395-6668
Mailing address
1 PRESTIGE PL STE 550, MIAMISBURG, OH 45342-6115
(937) 766-2131
(937) 522-8068
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
35.096488
OH
207R00000X
Internal Medicine Physician
44158
KY
208M00000X
Hospitalist Physician
Primary
35.096488
OH
208M00000X
Hospitalist Physician
44158
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0054670
—
OH
05
—
7100174450
—
KY
Enumeration date
10/28/2008
Last updated
05/05/2023
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