MEDICARE: ALLIANCE PHYSICIANS 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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1679895536
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLIANCE PHYSICIANS INC

Provider Business Mailing Address
First Line	:	2110 LEITER RD
Second Line	:
City	:	MIAMISBURG
State	:	OH
Zip	:	45342-3660
Country	:	US
Telephone Number	:	937-384-4838
Fax Number	:	937-384-4845

Provider Business Practice Location Address
First Line	:	1625 S ALEX RD
Second Line	:
City	:	WEST CARROLLTON
State	:	OH
Zip	:	45449-5404
Country	:	US
Telephone Number	:	937-865-0534
Fax Number	:	937-865-0721

Authorized Official
Title or Position	:	DIRECTOR OF NETWORK OPERATIONS
Name	:	DANIEL D HAIBACH
Credential	:
Telephone Number	:	937-384-4838

Provider Enumeration Date	:	02/19/2010
Last Update Date	:	04/16/2010

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