Healthcare Provider Details

I. General information

NPI: 1942448212
Provider Name (Legal Business Name): ANOOPA PATEL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2009
Last Update Date: 01/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 E STROOP RD
KETTERING OH
45429-2825
US

IV. Provider business mailing address

PO BOX 292410
KETTERING OH
45429-0410
US

V. Phone/Fax

Practice location:
  • Phone: 937-293-5352
  • Fax: 937-293-5566
Mailing address:
  • Phone: 937-293-5352
  • Fax: 937-293-5566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number35079223P
License Number StateOH

VIII. Authorized Official

Name: MRS. AMY N DAHM
Title or Position: BILLING
Credential:
Phone: 937-293-5352