Healthcare Provider Details

I. General information

NPI: 1356558894
Provider Name (Legal Business Name): ASHOK K. AMMULA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 04/06/2022
Certification Date: 04/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 WASHINGTON VILLAGE DR. SUITE 230
DAYTON OH
45459-3267
US

IV. Provider business mailing address

7700 WASHINGTON VILLAGE DR. SUITE 220
DAYTON OH
45459-3267
US

V. Phone/Fax

Practice location:
  • Phone: 937-438-3132
  • Fax: 937-438-8707
Mailing address:
  • Phone: 937-312-6551
  • Fax: 937-438-0902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number35092062
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: