MEDICARE: DR. DENNIS MIN D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	207RG0100X	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	043814799	OTHER	OH	TAX ID#
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000000369974	OTHER	OH	ANTHEM

General Provider Information

NPI Number	:	1104808518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENNIS MIN D.O.

Provider Business Mailing Address
First Line	:	1537 SOUTH BREIEL BOULEVARD
Second Line	:
City	:	MIDDLETOWN
State	:	OH
Zip	:	45044-6703
Country	:	US
Telephone Number	:	513-425-8300
Fax Number	:	513-425-8301

Provider Business Practice Location Address
First Line	:	1537 SOUTH BREIEL BOULEVARD
Second Line	:
City	:	MIDDLETOWN
State	:	OH
Zip	:	45044-6703
Country	:	US
Telephone Number	:	513-425-8300
Fax Number	:	513-425-8301

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2005
Last Update Date	:	04/25/2014

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