Provider Demographics
NPI:1427276948
Name:VERDON, MICHAEL PETER (DO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:PETER
Last Name:VERDON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 203
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409-0203
Mailing Address - Country:US
Mailing Address - Phone:937-797-3137
Mailing Address - Fax:937-972-0445
Practice Address - Street 1:8805 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-1333
Practice Address - Country:US
Practice Address - Phone:937-797-3137
Practice Address - Fax:937-972-0445
Is Sole Proprietor?:No
Enumeration Date:2007-04-22
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101016571207T00000X
OH34.010743207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP02230429OtherRRMEDICARE PTAN
OH0081940Medicaid
OHH698971OtherMEDICARE PTAN