Healthcare Provider Details

I. General information

NPI: 1215993415
Provider Name (Legal Business Name): J MICHAEL THUNEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 09/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4441 FAR HILLS AVE
KETTERING OH
45429-2405
US

IV. Provider business mailing address

2110 LEITER RD
MIAMISBURG OH
45342-3660
US

V. Phone/Fax

Practice location:
  • Phone: 937-298-7351
  • Fax: 937-298-9458
Mailing address:
  • Phone: 937-384-4838
  • Fax: 937-384-4845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35050734
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: