Healthcare Provider Details

I. General information

NPI: 1386649598
Provider Name (Legal Business Name): GURMEET S DHILLON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 04/08/2022
Certification Date: 04/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 KENNEDY AVE
CINCINNATI OH
45213-2664
US

IV. Provider business mailing address

5400 KENNEDY AVE
CINCINNATI OH
45213-2664
US

V. Phone/Fax

Practice location:
  • Phone: 513-281-3400
  • Fax: 513-527-2275
Mailing address:
  • Phone: 513-281-3400
  • Fax: 513-527-2275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number15407
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number227022
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD059744L
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number38772
License Number StateKY
# 5
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number35-083832
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: