Provider Demographics
NPI:1770044976
Name:DAYTON PULMONARY AND SLEEP MEDICINE
Entity Type:Organization
Organization Name:DAYTON PULMONARY AND SLEEP MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FAHIM
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-534-0155
Mailing Address - Street 1:2249 ANNANDALE PL
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-9121
Mailing Address - Country:US
Mailing Address - Phone:937-534-0155
Mailing Address - Fax:937-534-0166
Practice Address - Street 1:2249 ANNANDALE PL
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-9121
Practice Address - Country:US
Practice Address - Phone:937-534-0155
Practice Address - Fax:937-534-0166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-29
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0066316Medicaid