Individual
MICHAEL R HUMPHREY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
730 W MARKET ST, LIMA, OH 45801-4602
(419) 227-3361
Mailing address
4750 HEMPSTEAD STATION DR, KETTERING, OH 45429-5164
(800) 875-0136
(937) 619-4150
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
35057636
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000317841
ANTHEM/BCBS
OH
05
—
0722883
—
OH
01
—
P00088335
MEDICARE RR
OH
Enumeration date
06/03/2006
Last updated
11/01/2012
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