Healthcare Provider Details

I. General information

NPI: 1568743292
Provider Name (Legal Business Name): ALLIANCE PHYSICIAN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2011
Last Update Date: 03/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3533 SOUTHERN BLVD SUITE 3750
KETTERING OH
45429-1264
US

IV. Provider business mailing address

2110 LEITER RD
MIAMISBURG OH
45342-3660
US

V. Phone/Fax

Practice location:
  • Phone: 937-395-8304
  • Fax: 937-395-6004
Mailing address:
  • Phone: 937-384-4838
  • Fax: 937-384-4845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: DUANE A SHELDON
Title or Position: DIRECTOR OF REVENUE CYCLE
Credential:
Phone: 912-424-8443