Healthcare Provider Details

I. General information

NPI: 1114398203
Provider Name (Legal Business Name): DB MD WCC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2015
Last Update Date: 02/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR
MIDDLETOWN OH
45005-2584
US

IV. Provider business mailing address

3868 MCMANN RD UNIT A
CINCINNATI OH
45245-2306
US

V. Phone/Fax

Practice location:
  • Phone: 513-843-7632
  • Fax: 513-843-7945
Mailing address:
  • Phone: 513-843-7632
  • Fax: 513-843-7945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35066726
License Number StateOH

VIII. Authorized Official

Name: DANIEL A BUTLER
Title or Position: OWNER
Credential: M.D.
Phone: 513-843-7632