Healthcare Provider Details

I. General information

NPI: 1659202869
Provider Name (Legal Business Name): KATIE GREENBERG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 E MAIN ST
TROY OH
45373-3416
US

IV. Provider business mailing address

617 E MAIN ST
TROY OH
45373-3416
US

V. Phone/Fax

Practice location:
  • Phone: 937-332-6780
  • Fax:
Mailing address:
  • Phone: 937-332-6780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberLPN.158375.MEDS-IV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: