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General NPI Number Information
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NPI Number | 1487022927
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Entity Type | Organization
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Legal Business Name | FIRST TEAM MEDICAL CLINICS, LLC
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Dates
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Enumeration Date | 09/14/2015
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Last Update Date | 09/14/2015
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Provider Practice Location Address
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Address Line | 1654 MARDON DR
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City | BEAVERCREEK
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State | OH
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Zip | 45432-1949
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Country | US
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Telephone | 937-426-9265
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Fax |
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Provider Business Mailing Address
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Address Line | 1654 MARDON DR
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City | BEAVERCREEK
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State | OH
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Zip | 45432-1949
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Country | US
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Telephone | 937-426-9265
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. GREGORY PAUL PALKOWSKI
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Credential |
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Telephone | 937-426-9265
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 905
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License Number State | OH
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