MEDICARE: PROGRESSIVE INTERNAL MEDICINE, INC.

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	207R00000X	Internal Medicine Physician	71129	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184619207
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROGRESSIVE INTERNAL MEDICINE, INC.

Provider Business Mailing Address
First Line	:	38 REMICK BLVD
Second Line	:
City	:	SPRINGBORO
State	:	OH
Zip	:	45066-9168
Country	:	US
Telephone Number	:	937-886-1100
Fax Number	:	937-886-1101

Provider Business Practice Location Address
First Line	:	38 REMICK BLVD
Second Line	:
City	:	SPRINGBORO
State	:	OH
Zip	:	45066-9168
Country	:	US
Telephone Number	:	937-886-1100
Fax Number	:	937-886-1101

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RAMAN KHOSLA
Credential	:	M.D.
Telephone Number	:	937-287-5435

Provider Enumeration Date	:	09/14/2005
Last Update Date	:	06/30/2014

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