MEDICARE: HENRY MICHAEL DUKE MD

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	207ND0101X	MOHS-Micrographic Surgery Physician	35-04-4327	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000012628	OTHER	OH	ANTHEM
2	311159796028	OTHER	OH	CARESOURCE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891783494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HENRY MICHAEL DUKE MD

Provider Business Mailing Address
First Line	:	6210 N MAIN ST
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45415-3111
Country	:	US
Telephone Number	:	937-275-6647
Fax Number	:	937-275-7643

Provider Business Practice Location Address
First Line	:	6210 N MAIN ST
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45415-3111
Country	:	US
Telephone Number	:	937-275-6647
Fax Number	:	937-275-7643

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

Provider Enumeration Date	:	10/10/2005
Last Update Date	:	10/14/2010

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