Organization
KETTERING RADIOLOGIST IMAGING CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RONALD J FADELL MD (PRESIDENT)
(937) 439-7861
Entity
Organization
Contact information
Practice address
540 LINCOLN PARK BLVD, SUITE 100, KETTERING, OH 45429-6401
(937) 439-7861
Mailing address
PO BOX 713082, COLUMBUS, OH 43271-3082
(614) 430-5707
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000018662
ANTHEM
—
05
—
0604144
—
OH
01
—
CK1062
MEDICARE RAILROAD
—
Enumeration date
05/09/2006
Last updated
04/20/2008
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