Healthcare Provider Details

I. General information

NPI: 1275735474
Provider Name (Legal Business Name): CARDIOLOGY SPECIALISTS OF DAYTON INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 COMMONS BLVD SUITE 200B
BEAVERCREEK OH
45431-3809
US

IV. Provider business mailing address

PO BOX 634766
CINCINNATI OH
45263-0042
US

V. Phone/Fax

Practice location:
  • Phone: 937-454-9527
  • Fax: 937-454-9532
Mailing address:
  • Phone: 440-716-1283
  • Fax: 440-716-1605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT BULOW
Title or Position: PRESIDENT
Credential: DO
Phone: 937-454-9527