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General NPI Number Information
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NPI Number | 1861774168
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Entity Type | Organization
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Legal Business Name | ALLIANCE PHYSICIAN INC
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Dates
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Enumeration Date | 09/13/2011
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Last Update Date | 09/13/2011
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Provider Practice Location Address
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Address Line | 8057 WASHINGTON VILLAGE DR
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City | CENTERVILLE
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State | OH
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Zip | 45458-1847
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Country | US
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Telephone | 937-312-9890
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Fax | 937-312-9810
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Provider Business Mailing Address
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Address Line | 2110 LEITER RD
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City | MIAMISBURG
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State | OH
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Zip | 45342-3660
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Country | US
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Telephone | 937-384-4838
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Fax | 937-384-4845
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Authorized Official
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Title or Position | DIRECTOR BUSINESS DEVELOPMENT
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Name | DANIEL D HAIBACH
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Credential |
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Telephone | 937-558-3222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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