Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 35.075586 | OH |
Y | 207QA0401X | Family Doctor - Addiction Medicine | 35.075586 | OH |
NPI | 1801182738 |
---|---|
Provider Name | Ronald Suprenant |
First Address | Miamisburg, OH 45342 |
Second Address | Miamisburg, OH 45342 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2011 |
Last Update Date | 25/04/2013 |