Healthcare Provider Details

I. General information

NPI: 1386014298
Provider Name (Legal Business Name): CINCINNATI PAIN PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2015
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8261 CORNELL RD STE 630
CINCINNATI OH
45249-2279
US

IV. Provider business mailing address

8261 CORNELL RD SUITE 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:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.17640-NP
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

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