Healthcare Provider Details

I. General information

NPI: 1235115809
Provider Name (Legal Business Name): MICHAEL J REBAR DO, DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 09/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 E APPLE ST SUITE 6250
DAYTON OH
45409-2939
US

IV. Provider business mailing address

30 E APPLE ST SUITE 6250
DAYTON OH
45409-2939
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-8394
  • Fax: 937-420-8838
Mailing address:
  • Phone: 937-208-8394
  • Fax: 937-420-8838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number34007200
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number34007200
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: