Healthcare Provider Details

I. General information

NPI: 1912087511
Provider Name (Legal Business Name): DAYTON ARTHRITIS AND ALLERGY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 09/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3075 GOVERNORS PLACE BLVD SUITE 110
DAYTON OH
45409-1323
US

IV. Provider business mailing address

3075 GOVERNORS PLACE BLVD SUITE 110
DAYTON OH
45409-1332
US

V. Phone/Fax

Practice location:
  • Phone: 937-296-0015
  • Fax:
Mailing address:
  • Phone: 937-296-0015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0001X
TaxonomyClinical & Laboratory Immunology (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL W. STEVENS
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 937-296-0015