Doctor Name: | DR. TERREN BURGESS KOLES |
NPI Number: | 1699831693 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.D. |
License Number: | 35050061K |
Business Practice Address: | 2912 Springboro Rd Suite Moraine, OH - 454391674 |
Business Phone Number: | 5136951468 |
Business Fax Number: | 5136952941 |
Mailing Address: | 2912 Springboro Rd, Suite 201 MORAINE |
State: | OH |
Postal Code: | 454391674 |
Phone Number: | 9378851927 |
Fax Number: | |
NPI Enumeration Date: | 12/28/2006 |
NPI Last Update Date: | 04/13/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 35050061K |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OH |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |