Healthcare Provider Details

I. General information

NPI: 1619953742
Provider Name (Legal Business Name): PAUL J OPSAHL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4353 E STATE ROUTE 73 STE 120
WAYNESVILLE OH
45068-8814
US

IV. Provider business mailing address

2912 SPRINGBORO W SUITE 201
DAYTON OH
45439-1674
US

V. Phone/Fax

Practice location:
  • Phone: 513-897-0085
  • Fax: 513-897-0194
Mailing address:
  • Phone: 513-897-0085
  • Fax: 513-897-0194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35047593
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: