Provider Demographics
NPI:1194841924
Name:H MICHAEL DUKE MD INC.
Entity Type:Organization
Organization Name:H MICHAEL DUKE MD INC.
Other - Org Name:ADVANCED DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:DUKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-275-6647
Mailing Address - Street 1:6210 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-3111
Mailing Address - Country:US
Mailing Address - Phone:937-275-6647
Mailing Address - Fax:937-275-7643
Practice Address - Street 1:6210 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-3111
Practice Address - Country:US
Practice Address - Phone:937-275-6647
Practice Address - Fax:937-275-7643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0869056Medicaid
OH0869056Medicaid