Healthcare Provider Details

I. General information

NPI: 1841606985
Provider Name (Legal Business Name): JONATHAN SUTERMEISTER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2014
Last Update Date: 07/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3260 GAMBIT SQ
DAYTON OH
45449-3513
US

IV. Provider business mailing address

3260 GAMBIT SQ
DAYTON OH
45449-3513
US

V. Phone/Fax

Practice location:
  • Phone: 937-367-5542
  • Fax:
Mailing address:
  • Phone: 937-367-5542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: