Provider Demographics
NPI:1093904849
Name:MIAMI FAMILY PHYSICIANS INC
Entity Type:Organization
Organization Name:MIAMI FAMILY PHYSICIANS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:SPAGNOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-335-5727
Mailing Address - Street 1:998 S DORSET RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-4753
Mailing Address - Country:US
Mailing Address - Phone:937-335-5727
Mailing Address - Fax:
Practice Address - Street 1:998 DORSET
Practice Address - Street 2:SUITE 207
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373
Practice Address - Country:US
Practice Address - Phone:937-335-5727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2995684Medicaid
OHCF6675Medicare PIN
9371861Medicare PIN