Provider Demographics
NPI:1093837569
Name:MIAMI VALLEY PLASTIC SURGEONS, INC.
Entity Type:Organization
Organization Name:MIAMI VALLEY PLASTIC SURGEONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:WELTY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:937-228-5115
Mailing Address - Street 1:1520 S MAIN ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409-2698
Mailing Address - Country:US
Mailing Address - Phone:937-228-5115
Mailing Address - Fax:937-228-4591
Practice Address - Street 1:1520 S MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-2698
Practice Address - Country:US
Practice Address - Phone:937-228-5115
Practice Address - Fax:937-228-4591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty