Organization
KETTERING INDEPENDENT MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY Y KO (CFO)
(937) 558-3223
Entity
Organization
Contact information
Practice address
113 W NATIONAL RD, VANDALIA, OH 45377-1934
(937) 898-5615
Mailing address
1 PRESTIGE PL, SUITE 550, MIAMISBURG, OH 45342-3794
(937) 762-1306
(937) 522-7626
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
01/12/2011
Last updated
06/13/2023
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