MEDICARE: DAYTON ARTHRITIS AND ALLERGY CENTER LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207RI0001X	Clinical & Laboratory Immunology (Internal Medicine) Physician
2	2080P0201X	Pediatric Allergy/Immunology Physician
3	207RR0500X	Rheumatology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CJ9805	OTHER	OH	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912087511
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAYTON ARTHRITIS AND ALLERGY CENTER LLC

Provider Business Mailing Address
First Line	:	3075 GOVERNORS PLACE BLVD
Second Line	:	SUITE 110
City	:	DAYTON
State	:	OH
Zip	:	45409-1332
Country	:	US
Telephone Number	:	937-296-0015
Fax Number	:

Provider Business Practice Location Address
First Line	:	3075 GOVERNORS PLACE BLVD
Second Line	:	SUITE 110
City	:	DAYTON
State	:	OH
Zip	:	45409-1323
Country	:	US
Telephone Number	:	937-296-0015
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. MICHAEL W. STEVENS
Credential	:	M.D.
Telephone Number	:	937-296-0015

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	09/24/2008

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Directions to “DAYTON ARTHRITIS AND ALLERGY CENTER LLC ” Practice Location

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