Healthcare Provider Details

I. General information

NPI: 1598764391
Provider Name (Legal Business Name): CARDIOLOGY SPECIALISTS OF DAYTON INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4160 LITTLE YORK RD STE. 20
DAYTON OH
45414-5800
US

IV. Provider business mailing address

4160 LITTLE YORK RD STE. 20
DAYTON OH
45414-5800
US

V. Phone/Fax

Practice location:
  • Phone: 937-454-9527
  • Fax: 937-454-9532
Mailing address:
  • Phone: 937-454-9527
  • Fax: 937-454-9532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number34006383
License Number StateOH

VIII. Authorized Official

Name: ROBERT E BULOW
Title or Position: MANAGING PARTNER
Credential: DO
Phone: 937-454-9527