Organization
ALLIANCE PHYSICIAN INC
Active
Parent organization
ALLIANCE PHYSICIAN INC
Other names
Kettering Medical Center - Breast Evaluation Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
ALLIANCE PHYSICIAN INC
Authorized official
DANIEL D HAIBACH (DIRECTOR BUSINESS DEVELOPMENT)
(937) 914-7094
Entity
Organization
Contact information
Practice address
3535 SOUTHERN BLVD, SUITE B, KETTERING, OH 45429-1221
(937) 298-4331
Mailing address
2110 LEITER RD, MIAMISBURG, OH 45342-3660
(937) 384-4838
(937) 384-4845
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2712872
—
OH
Enumeration date
09/13/2011
Last updated
09/13/2011
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