Provider Demographics
NPI:1972792893
Name:DAYTON ORTHOPEDIC CENTER, INC
Entity Type:Organization
Organization Name:DAYTON ORTHOPEDIC CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ABDOLALI
Authorized Official - Middle Name:
Authorized Official - Last Name:ELMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-836-4042
Mailing Address - Street 1:9000 N MAIN ST
Mailing Address - Street 2:STE 201
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-1180
Mailing Address - Country:US
Mailing Address - Phone:937-836-4042
Mailing Address - Fax:937-836-2702
Practice Address - Street 1:9000 N MAIN ST
Practice Address - Street 2:STE 201
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-1180
Practice Address - Country:US
Practice Address - Phone:937-836-4042
Practice Address - Fax:937-836-2702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35047312207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9930851Medicare PIN