Healthcare Provider Details

I. General information

NPI: 1134185481
Provider Name (Legal Business Name): SANTOSH MENON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 12/09/2022
Certification Date: 12/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2123 AUBURN AVE SU. 137
CINCINNATI OH
45219-2906
US

IV. Provider business mailing address

237 WILLIAM HOWARD TAFT RD 2ND FLOOR, CBO2-3
CINCINNATI OH
45219-2610
US

V. Phone/Fax

Practice location:
  • Phone: 513-206-1180
  • Fax: 513-206-1182
Mailing address:
  • Phone: 513-206-1180
  • Fax: 513-206-1182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35077748
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License Number35077748
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: