MEDICARE: KETTERING PEDIATRIC & FAMILY CARE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1730837394
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KETTERING PEDIATRIC & FAMILY CARE, INC.

Provider Business Mailing Address
First Line	:	5250 FAR HILLS AVE STE 260
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45429-2357
Country	:	US
Telephone Number	:	937-293-4168
Fax Number	:	937-293-2235

Provider Business Practice Location Address
First Line	:	5250 FAR HILLS AVE STE 260
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45429-2357
Country	:	US
Telephone Number	:	937-293-4168
Fax Number	:	937-293-2235

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RAMZIEH AZMEH
Credential	:	MD
Telephone Number	:	937-293-4168

Provider Enumeration Date	:	03/14/2022
Last Update Date	:	03/14/2022

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