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Individual

DR. PETER KIRK DERUSSY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
2115 LEITER RD, MIAMISBURG, OH 45342-3659
(937) 384-6800
(937) 384-6939
Mailing address
6661 CLYO RD, CENTERVILLE, OH 45459-2702
(937) 425-4000
(937) 425-4002

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
35 076115
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2507184
OH
Enumeration date
11/10/2005
Last updated
02/01/2021
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