Healthcare Provider Details

I. General information

NPI: 1386200533
Provider Name (Legal Business Name): LASER NECK AND BACK CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2019
Last Update Date: 05/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10475 READING RD STE 115
CINCINNATI OH
45241-2500
US

IV. Provider business mailing address

77 W ELMWOOD DR STE 211
DAYTON OH
45459-4263
US

V. Phone/Fax

Practice location:
  • Phone: 937-000-0000
  • Fax: 937-000-0000
Mailing address:
  • Phone: --
  • Fax: --

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: RAJ V KAKARLAPUDI
Title or Position: OWNER
Credential: MD
Phone: 859-446-3106