Healthcare Provider Details

I. General information

NPI: 1023091055
Provider Name (Legal Business Name): VENKATACHALAM MUTHIAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 04/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ELIZABETH PL SUITE 190
DAYTON OH
45408-1445
US

IV. Provider business mailing address

7073 CLYO ROAD
CENTERVILLE OH
45459
US

V. Phone/Fax

Practice location:
  • Phone: 937-222-3118
  • Fax: 937-222-1436
Mailing address:
  • Phone: 937-435-5857
  • Fax: 937-912-4960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number35334
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: