Healthcare Provider Details

I. General information

NPI: 1528718723
Provider Name (Legal Business Name): JACOB DICKMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2022
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 LEITER RD
MIAMISBURG OH
45342-3600
US

IV. Provider business mailing address

1 PRESTIGE PL STE 550
MIAMISBURG OH
45342-6115
US

V. Phone/Fax

Practice location:
  • Phone: 937-384-6800
  • Fax: 937-384-6938
Mailing address:
  • Phone: 937-762-1306
  • Fax: 937-522-7017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.154145
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: