=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730135831
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAMA MURTHY DONTHI MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/26/2006
-----------------------------------------------------
Last Update Date | 02/08/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 190 N UNION ST STE 203
-----------------------------------------------------
City | AKRON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44304-1362
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-923-3502
-----------------------------------------------------
Fax | 330-928-9761
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 601 E MAIN ST STE 101
-----------------------------------------------------
City | MAHOMET
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61853-7460
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-359-6001
-----------------------------------------------------
Fax | 913-359-5552
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 35040344
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------