Provider Demographics
NPI:1336458744
Name:KILEY, HARVEY C (DO)
Entity Type:Individual
Prefix:DR
First Name:HARVEY
Middle Name:C
Last Name:KILEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2413 BRIGGS RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-6642
Mailing Address - Country:US
Mailing Address - Phone:937-684-0104
Mailing Address - Fax:
Practice Address - Street 1:3063 HARVEYSBURG RD
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:OH
Practice Address - Zip Code:45068-9420
Practice Address - Country:US
Practice Address - Phone:937-725-5006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-02
Last Update Date:2010-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-001397208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice