Organization
KETTERING UROLOGY INSTITUTE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDWARD C JACOBS M.D. (PRESIDENT)
(937) 547-0330
Entity
Organization
Contact information
Practice address
3533 SOUTHERN BLVD, STE 5800, KETTERING, OH 45429-1264
(937) 438-7682
(937) 547-2575
Mailing address
114 S BROADWAY ST, GREENVILLE, OH 45331-1902
(937) 547-0330
(937) 547-2575
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
35-07-3367
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
35-07-3367
LICENSE
OH
Enumeration date
10/06/2008
Last updated
10/06/2008
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