Healthcare Provider Details

I. General information

NPI: 1487814000
Provider Name (Legal Business Name): ASHOK POLURI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2008
Last Update Date: 07/25/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6730 ROOSEVELT AVE STE 303
MIDDLETOWN OH
45005-0017
US

IV. Provider business mailing address

PO BOX 229
MIAMISBURG OH
45343-0229
US

V. Phone/Fax

Practice location:
  • Phone: 513-874-0486
  • Fax: 513-280-8868
Mailing address:
  • Phone: 513-874-0486
  • Fax: 513-280-8868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number47220
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number35-124217
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number47220
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number35-124217
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number47220
License Number StateKY
# 6
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number35-124217
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: