Organization
ALLIANCE PHYSICIAN INC
Active
Parent organization
ALLIANCE PHYSICIAN INC
Other names
Kettering Vascular Surgery Associates
Organization subpart
Yes
Provider details
NPI number
Legal business name
ALLIANCE PHYSICIAN INC
Authorized official
DANIEL D HAIBACH (DIRECTOR BUSINESS DEVELOPMENT)
(937) 558-3222
Entity
Organization
Contact information
Practice address
2141 N FAIRFIELD RD, SUITE B, BEAVERCREEK, OH 45431-2579
(937) 458-0085
(937) 458-0212
Mailing address
2110 LEITER RD, MIAMISBURG, OH 45342-3660
(937) 384-4838
(937) 384-4845
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
2086S0129X
Vascular Surgery Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2712872
—
OH
Enumeration date
09/13/2011
Last updated
09/09/2013
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