Healthcare Provider Details

I. General information

NPI: 1801890793
Provider Name (Legal Business Name): MICHAEL ALAN RALSTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 10/16/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS PLZ
DAYTON OH
45404-1815
US

IV. Provider business mailing address

PO BOX 933432
CLEVELAND OH
44193-0039
US

V. Phone/Fax

Practice location:
  • Phone: 937-641-3418
  • Fax: 937-641-5413
Mailing address:
  • Phone: 937-641-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number35.052636
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: