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General NPI Number Information
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NPI Number | 1407172042
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Entity Type | Organization
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Legal Business Name | KETTERING REPRODUCTIVE LABORATORY INC
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Dates
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Enumeration Date | 04/07/2010
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Last Update Date | 04/07/2010
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Provider Practice Location Address
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Address Line | 3533 SOUTHERN BLVD STE 4100
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City | KETTERING
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State | OH
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Zip | 45429-1264
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Country | US
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Telephone | 330-687-7975
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Fax |
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Provider Business Mailing Address
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Address Line | 8210 MACEDONIA COMMONS BLVD STE 68-105
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City | MACEDONIA
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State | OH
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Zip | 44056-1860
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Country | US
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Telephone | 330-687-7975
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MAXIM E RYGOVSKIY
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Credential |
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Telephone | 330-687-7975
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 36D0957636
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License Number State | OH
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