Organization
KETTERING INDEPENDENT MEDICAL GROUP INC
Active
Organization
KETTERING INDEPENDENT MEDICAL GROUP INC
Active
Other names
Kettering Specialty Care, Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY Y KO (CHIEF FINANCIAL OFFICER)
(937) 395-8522
Entity
Organization
Contact information
Practice address
1 PRESTIGE PL, SUITE 910, MIAMISBURG, OH 45342-3794
(937) 762-1629
Mailing address
1 PRESTIGE PL STE 550, MIAMISBURG, OH 45342-6115
(937) 762-1310
(937) 522-8068
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
208600000X
Surgery Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0207472
—
OH
Enumeration date
10/06/2010
Last updated
03/27/2023
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