Healthcare Provider Details

I. General information

NPI: 1285636050
Provider Name (Legal Business Name): MICHAEL JOHN VALLE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 05/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1975 MIAMISBURG CENTERVILLE RD
CENTERVILLE OH
45459-3811
US

IV. Provider business mailing address

1975 MIAMISBURG CENTERVILLE RD
CENTERVILLE OH
45459-3811
US

V. Phone/Fax

Practice location:
  • Phone: 937-439-6186
  • Fax: 937-439-9900
Mailing address:
  • Phone: 937-439-6186
  • Fax: 937-439-9900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number34-00-5041-V
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number34-00-5041-V
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: