=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942448212
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANOOPA PATEL LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2009
-----------------------------------------------------
Last Update Date | 01/26/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 207 E STROOP RD
-----------------------------------------------------
City | KETTERING
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45429-2825
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-293-5352
-----------------------------------------------------
Fax | 937-293-5566
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 292410
-----------------------------------------------------
City | KETTERING
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45429-0410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-293-5352
-----------------------------------------------------
Fax | 937-293-5566
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING
-----------------------------------------------------
Name | MRS. AMY N DAHM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 937-293-5352
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 173000000X
-----------------------------------------------------
Taxonomy Name | Legal Medicine
-----------------------------------------------------
License Number | 35079223P
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------