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General NPI Number Information
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NPI Number | 1316923915
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Entity Type | Organization
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Legal Business Name | DAYTON INTERVENTIONAL RADIOLOGY LLC
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Dates
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Enumeration Date | 12/16/2005
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Last Update Date | 10/13/2021
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Provider Practice Location Address
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Address Line | 3075 GOVERNORS PLACE BLVD
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City | KETTERING
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State | OH
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Zip | 45409-1323
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Country | US
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Telephone | 937-765-3113
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 412865
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City | BOSTON
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State | MA
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Zip | 02241-2865
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Country | US
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Telephone | 610-644-8900
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Fax | 484-924-0053
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Authorized Official
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Title or Position | SR. VICE PRESIDENT
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Name | GREGG MILLER
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Credential | MD
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Telephone | 610-644-8900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 36.003246
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number |
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License Number State |
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