Healthcare Provider Details

I. General information

NPI: 1760684682
Provider Name (Legal Business Name): CARDIOLOGY SPECIALISTS OF DAYTON INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

1512 YANKEE PARK PL
CENTERVILLE FINANCE OH
45458-1878
US

IV. Provider business mailing address

PO BOX 634766
CINCINNATI OH
45263-0042
US

V. Phone/Fax

Practice location:
  • Phone: 937-434-3968
  • Fax: 937-434-4886
Mailing address:
  • Phone: 800-611-6912
  • 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: MD
Phone: 937-434-3968