Provider Demographics
NPI:1912128083
Name:PRENGER, ERIC JOHN (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:JOHN
Last Name:PRENGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 WEST MICHIGAN STREET
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:OH
Mailing Address - Zip Code:45365
Mailing Address - Country:US
Mailing Address - Phone:937-492-4890
Mailing Address - Fax:937-492-4836
Practice Address - Street 1:915 WEST MICHIGAN STREET
Practice Address - Street 2:BUILDING A
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365
Practice Address - Country:US
Practice Address - Phone:937-492-4890
Practice Address - Fax:937-492-4936
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35089087207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4207891Medicare PIN
OHI73419Medicare UPIN