Healthcare Provider Details

I. General information

NPI: 1902261431
Provider Name (Legal Business Name): BRYAN LEE SCHINAMAN PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2015
Last Update Date: 04/04/2022
Certification Date: 04/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6611 CLYO RD STE D
CENTERVILLE OH
45459-2785
US

IV. Provider business mailing address

3170 KETTERING BLVD BLDG B
MORAINE OH
45439-1924
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-7350
  • Fax:
Mailing address:
  • Phone: 937-991-3188
  • Fax: 937-223-9811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.004543RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: