Healthcare Provider Details

I. General information

NPI: 1659542322
Provider Name (Legal Business Name): RANDALL C OREM DO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2008
Last Update Date: 03/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 FAIRINGTON DR
SIDNEY OH
45365-8130
US

IV. Provider business mailing address

1103 FAIRINGTON DR
SIDNEY OH
45365-8130
US

V. Phone/Fax

Practice location:
  • Phone: 937-497-1200
  • Fax: 937-497-7013
Mailing address:
  • Phone: 937-497-1200
  • Fax: 937-497-7013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: RANDALL C OREM
Title or Position: PRESIDENT
Credential: DO
Phone: 937-497-1200