Healthcare Provider Details

I. General information

NPI: 1346908241
Provider Name (Legal Business Name): OHIOGIMD INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2021
Last Update Date: 12/08/2021
Certification Date: 12/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 W MAIN ST
WILLIAMSBURG OH
45176-1146
US

IV. Provider business mailing address

5824 OAK CREEK TRL
DAYTON OH
45424-4097
US

V. Phone/Fax

Practice location:
  • Phone: 937-716-1226
  • Fax:
Mailing address:
  • Phone: 559-800-1366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. KALYANI SHAH
Title or Position: OWNER
Credential: MD
Phone: 559-800-1366