Individual
ANN D DECLUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
990 BELVEDERE DR STE A, LEBANON, OH 45036-2890
(240) 313-9850
(240) 313-9851
Mailing address
990 BELVEDERE DR STE A, LEBANON, OH 45036-2890
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
35.120757
OH
207R00000X
Internal Medicine Physician
36073550
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0086602
—
OH
Enumeration date
10/03/2006
Last updated
11/06/2013
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