Healthcare Provider Details

I. General information

NPI: 1457790941
Provider Name (Legal Business Name): CINCINNATI PAIN PHYSICIANS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2013
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8261 CORNELL RD # 630
CINCINNATI OH
45249-2278
US

IV. Provider business mailing address

8261 CORNELL RD # 630
CINCINNATI OH
45249-2278
US

V. Phone/Fax

Practice location:
  • Phone: 513-891-0022
  • Fax: 513-672-0830
Mailing address:
  • Phone: 513-891-0022
  • Fax: 513-672-0830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number2199579
License Number StateOH

VIII. Authorized Official

Name: DR. GURURAU SUDARSHAN
Title or Position: MD/CEO
Credential:
Phone: 513-673-9612