MEDICARE: OHIOGIMD 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	174400000X	Specialist

General Provider Information

NPI Number	:	1346908241
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OHIOGIMD INC.

Provider Business Mailing Address
First Line	:	5824 OAK CREEK TRL
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45424-4097
Country	:	US
Telephone Number	:	559-800-1366
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 W MAIN ST
Second Line	:
City	:	WILLIAMSBURG
State	:	OH
Zip	:	45176-1146
Country	:	US
Telephone Number	:	937-716-1226
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KALYANI SHAH
Credential	:	MD
Telephone Number	:	559-800-1366

Provider Enumeration Date	:	12/08/2021
Last Update Date	:	12/08/2021

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Directions to “OHIOGIMD INC. ” Practice Location

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