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General NPI Number Information
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NPI Number | 1740501329
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Entity Type | Individual
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Provider Name | SUNIL PATHAK MISRA M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/17/2010
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Last Update Date | 11/11/2016
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Provider Practice Location Address
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Address Line | 375 DIXMYTH AVE
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City | CINCINNATI
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State | OH
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Zip | 45220-2475
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Country | US
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Telephone | 523-862-3710
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Fax | 513-965-8091
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Provider Business Mailing Address
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Address Line | PO BOX 42456
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City | CINCINNATI
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State | OH
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Zip | 45242-0456
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Country | US
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Telephone | 513-965-8041
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Fax | 513-965-8091
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 2011012271
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 127871
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 49431
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License Number State | KY
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