Healthcare Provider Details

I. General information

NPI: 1740453984
Provider Name (Legal Business Name): SPRINGBORO FAMILY MEDICINE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2008
Last Update Date: 04/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 SYCAMORE CREEK DRIVE
SPRINGBORO OH
45066
US

IV. Provider business mailing address

5 SYCAMORE CREEK DRIVE
SPRINGBORO OH
45066
US

V. Phone/Fax

Practice location:
  • Phone: 937-748-4211
  • Fax: 937-748-3566
Mailing address:
  • Phone: 937-748-4211
  • Fax: 937-748-3566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34008059M
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateOH

VIII. Authorized Official

Name: MRS. SUSAN BETH GRAU
Title or Position: PHYSICIAN
Credential: MD
Phone: 937-748-4211