Healthcare Provider Details

I. General information

NPI: 1801073226
Provider Name (Legal Business Name): VIJAY KRISHNAKUMAR SRINIVASA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2008
Last Update Date: 08/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

559 OLD STATE ROUTE 74
CINCINNATI OH
45244-1518
US

IV. Provider business mailing address

5400 DUPONT CIRCLE SUITE A
MILFORD OH
45154
US

V. Phone/Fax

Practice location:
  • Phone: 513-732-2820
  • Fax: 513-732-2814
Mailing address:
  • Phone: 513-576-7700
  • Fax: 513-576-1020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.095716
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: