Healthcare Provider Details

I. General information

NPI: 1467405225
Provider Name (Legal Business Name): CLYO INTERNAL MEDICINE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7073 CLYO RD
CENTERVILLE OH
45459-4816
US

IV. Provider business mailing address

7073 CLYO RD
CENTERVILLE OH
45459-4816
US

V. Phone/Fax

Practice location:
  • Phone: 937-435-5857
  • Fax: 937-912-4960
Mailing address:
  • Phone: 937-435-5857
  • Fax: 937-912-4960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: GARY JOHN PALMER
Title or Position: OWNER
Credential: M.D.
Phone: 937-435-5857