Healthcare Provider Details

I. General information

NPI: 1811944531
Provider Name (Legal Business Name): PREMIER CARDIOTHORACIC AND VASCULAR SURGEONS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 08/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 E APPLE ST STE 6200
DAYTON OH
45409-2939
US

IV. Provider business mailing address

PO BOX 73392
CLEVELAND OH
44193-0002
US

V. Phone/Fax

Practice location:
  • Phone: 937-275-5100
  • Fax: 937-275-4587
Mailing address:
  • Phone: 937-293-0247
  • Fax: 937-293-0960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: KOK H LIM
Title or Position: PRESIDENT
Credential: MD
Phone: 937-275-5100