Healthcare Provider Details

I. General information

NPI: 1245286715
Provider Name (Legal Business Name): DAYTON COLON RECTAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 10/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5932 SPRINGBORO PIKE
DAYTON OH
45449-3250
US

IV. Provider business mailing address

5932 SPRINGBORO PIKE
DAYTON OH
45449-3250
US

V. Phone/Fax

Practice location:
  • Phone: 937-435-8663
  • Fax: 937-435-8966
Mailing address:
  • Phone: 937-435-8663
  • Fax: 937-435-8966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DEEPAK KUMAR
Title or Position: PRESIDENT
Credential: M.D.
Phone: 937-435-8663