MEDICARE: DR. HENRY N MAIMON M.D.

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	31116-M	OH

General Provider Information

NPI Number	:	1871575761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HENRY N MAIMON M.D.

Provider Business Mailing Address
First Line	:	4200 INDIAN RIPPLE RD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45440-3248
Country	:	US
Telephone Number	:	937-427-1680
Fax Number	:	937-427-9081

Provider Business Practice Location Address
First Line	:	4200 INDIAN RIPPLE RD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45440-3248
Country	:	US
Telephone Number	:	937-427-1680
Fax Number	:	937-427-9081

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

Provider Enumeration Date	:	11/16/2005
Last Update Date	:	07/08/2007

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