MEDICARE: IMPERIAL ENTERPRISE OF OHIO LLC

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	207L00000X	Anesthesiology Physician

General Provider Information

NPI Number	:	1295111318
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMPERIAL ENTERPRISE OF OHIO LLC

Provider Business Mailing Address
First Line	:	PO BOX 340765
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45434-0765
Country	:	US
Telephone Number	:	618-554-3683
Fax Number	:

Provider Business Practice Location Address
First Line	:	245 W ELMWOOD DR STE 100
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45459-4259
Country	:	US
Telephone Number	:	618-554-3683
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ABDUL SHAHID
Credential	:
Telephone Number	:	618-554-3683

Provider Enumeration Date	:	07/31/2015
Last Update Date	:	06/11/2026

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