Healthcare Provider Details

I. General information

NPI: 1447807888
Provider Name (Legal Business Name): KALEIGH B GRUENBERG PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2019
Last Update Date: 01/07/2020
Certification Date: 01/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 W RAHN RD
DAYTON OH
45429-2219
US

IV. Provider business mailing address

33 W RAHN RD
DAYTON OH
45429-2219
US

V. Phone/Fax

Practice location:
  • Phone: 937-433-8990
  • Fax: 937-433-8691
Mailing address:
  • Phone: 937-433-8990
  • Fax: 937-433-8691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number50.006105RX
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50006105RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: