Provider Demographics
NPI:1265801195
Name:INTERNAL MEDICINE OF CENTERVILLE, LLC
Entity type:Organization
Organization Name:INTERNAL MEDICINE OF CENTERVILLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:H
Authorized Official - Last Name:KLUGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-681-9507
Mailing Address - Street 1:8002 MCEWEN RD
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45458-2033
Mailing Address - Country:US
Mailing Address - Phone:937-681-9507
Mailing Address - Fax:937-221-8242
Practice Address - Street 1:8002 MCEWEN RD
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45458-2033
Practice Address - Country:US
Practice Address - Phone:937-681-9507
Practice Address - Fax:937-221-8242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-22
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Single Specialty