Provider Demographics
NPI:1073196515
Name:MONROE, MICHEAL MAURICE
Entity Type:Individual
Prefix:
First Name:MICHEAL
Middle Name:MAURICE
Last Name:MONROE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 E RAHN RD
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-5462
Mailing Address - Country:US
Mailing Address - Phone:937-802-5440
Mailing Address - Fax:
Practice Address - Street 1:42 E RAHN RD
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-5462
Practice Address - Country:US
Practice Address - Phone:937-802-5440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-03
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator