Provider Demographics
NPI:1104808518
Name:MIN, DENNIS (DO)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:
Last Name:MIN
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 1:1537 SOUTH BREIEL BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45044-6703
Mailing Address - Country:US
Mailing Address - Phone:513-425-8300
Mailing Address - Fax:513-425-8301
Practice Address - Street 1:1537 SOUTH BREIEL BOULEVARD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044-6703
Practice Address - Country:US
Practice Address - Phone:513-425-8300
Practice Address - Fax:513-425-8301
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-20
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207RG0100X207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH043814799OtherTAX ID#
OH2460877Medicaid
OH000000369974OtherANTHEM
OH043814799OtherTAX ID#
OHH84230Medicare UPIN