Provider Demographics
NPI:1497037790
Name:ALLIANCE PHYSICIAN INC
Entity Type:Organization
Organization Name:ALLIANCE PHYSICIAN INC
Other - Org Name:SOUTH DAYTON INTERNISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR BUSINESS DEVELOPMENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:HAIBACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-558-3222
Mailing Address - Street 1:2110 LEITER RD
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-3660
Mailing Address - Country:US
Mailing Address - Phone:937-384-4838
Mailing Address - Fax:937-384-4845
Practice Address - Street 1:500 LINCOLN PARK BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-6410
Practice Address - Country:US
Practice Address - Phone:937-531-5020
Practice Address - Fax:937-298-4385
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALLIANCE PHYSICIAN INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2712872Medicaid
OH9306898Medicare PIN