Healthcare Provider Details

I. General information

NPI: 1053773838
Provider Name (Legal Business Name): DAYTON SPRINGFIELD HEART AND VASCULAR MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 04/02/2021
Certification Date: 04/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7111 N. MAIN ST. SUITE 50
DAYTON OH
45415-2558
US

IV. Provider business mailing address

7111 N. MAIN ST. SUITE 50
DAYTON OH
45415-2558
US

V. Phone/Fax

Practice location:
  • Phone: 937-424-5986
  • Fax: 937-424-5989
Mailing address:
  • Phone: 937-424-5986
  • Fax: 937-424-5989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35.074802
License Number StateOH

VIII. Authorized Official

Name: DR. MOHAMMAD ANWARUL KABIR
Title or Position: OWNER
Credential: M.D.
Phone: 937-424-5986