Healthcare Provider Details

I. General information

NPI: 1093772097
Provider Name (Legal Business Name): PAUL G KOLES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 04/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3640 COLONEL GLENN HWY 125 WHITE HALL
DAYTON OH
45435-0001
US

IV. Provider business mailing address

725 UNIVERSITY BLVD
DAYTON OH
45435-0001
US

V. Phone/Fax

Practice location:
  • Phone: 937-775-2625
  • Fax: 937-775-2633
Mailing address:
  • Phone: 937-245-7100
  • Fax: 937-245-7999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number35046638
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: