Healthcare Provider Details

I. General information

NPI: 1184172629
Provider Name (Legal Business Name): MICHAEL DEYHLE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2016
Last Update Date: 09/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 N MAIN ST SUITE G-35
ENGLEWOOD OH
45415-1180
US

IV. Provider business mailing address

136 S LUDLOW ST SUITE G-35
DAYTON OH
45402-1813
US

V. Phone/Fax

Practice location:
  • Phone: 937-836-1028
  • Fax:
Mailing address:
  • Phone: 937-499-8262
  • Fax: 937-223-9811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: