Healthcare Provider Details

I. General information

NPI: 1174660831
Provider Name (Legal Business Name): KUDDYTHAMBY SINNATHAMBY, MD.,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 10/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5538 PHILADELPHIA DR
DAYTON OH
45415-3062
US

IV. Provider business mailing address

5538 PHILADELPHIA DR
DAYTON OH
45415-3062
US

V. Phone/Fax

Practice location:
  • Phone: 937-278-3625
  • Fax: 937-278-3431
Mailing address:
  • Phone: 937-278-3625
  • Fax: 937-278-3431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35032806
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35072640
License Number StateOH

VIII. Authorized Official

Name: DR. KITREN B SINNATHAMBY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 937-278-3625