Healthcare Provider Details

I. General information

NPI: 1699767269
Provider Name (Legal Business Name): MICHAEL P. REGAN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 06/15/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 W GRAND AVE STE 3002
DAYTON OH
45405-4722
US

IV. Provider business mailing address

PO BOX 1022
DAYTON OH
45401-1022
US

V. Phone/Fax

Practice location:
  • Phone: 937-723-4231
  • Fax: 937-734-4170
Mailing address:
  • Phone: 937-221-8555
  • Fax: 937-567-4170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number36002164R
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: