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General NPI Number Information
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NPI Number | 1184666497
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Entity Type | Organization
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Legal Business Name | HIGHLAND HOSPITALIST SERVICES MEDICAL GROUP
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Dates
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Enumeration Date | 06/12/2006
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Last Update Date | 10/15/2007
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Provider Practice Location Address
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Address Line | 1275 N HIGH ST
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City | HILLSBORO
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State | OH
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Zip | 45133-8273
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Country | US
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Telephone | 937-393-6100
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Fax | 937-393-6333
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Provider Business Mailing Address
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Address Line | 4750 HEMPSTEAD STATION DR
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City | KETTERING
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State | OH
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Zip | 45429-5164
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Country | US
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Telephone | 800-875-0136
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Fax | 937-619-4231
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Authorized Official
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Title or Position | CEO
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Name | PAUL W KOLODZIK
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Credential | MD
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Telephone | 800-875-0136
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 1572198
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License Number State | OH
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