Provider Demographics
NPI:1033322334
Name:DAYTON INTERNAL MEDICINE CLINIC, INC.
Entity Type:Organization
Organization Name:DAYTON INTERNAL MEDICINE CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:UGO
Authorized Official - Middle Name:O
Authorized Official - Last Name:NWOKORO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-224-4325
Mailing Address - Street 1:1735 BIG HILL RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45439-2201
Mailing Address - Country:US
Mailing Address - Phone:937-224-4325
Mailing Address - Fax:937-224-4327
Practice Address - Street 1:1735 BIG HILL RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45439-2201
Practice Address - Country:US
Practice Address - Phone:937-224-4325
Practice Address - Fax:937-224-4327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35078825N207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2244897Medicaid
OH2244897Medicaid