Provider Demographics
NPI:1295778546
Name:GALLUCH, DAVID B (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:B
Last Name:GALLUCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:140 W MAIN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45502-1312
Mailing Address - Country:US
Mailing Address - Phone:937-398-1066
Mailing Address - Fax:937-398-1076
Practice Address - Street 1:140 W MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45502-1312
Practice Address - Country:US
Practice Address - Phone:937-398-1066
Practice Address - Fax:937-398-1076
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2015-04-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35086227207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
11617155OtherCAQH
OH2690216OtherUNITED HEALTHCARE
OH2664175Medicaid
7810839OtherAETNA
OH159113Medicare UPIN
OH6203710001Medicare NSC
11617155OtherCAQH