=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982621751
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAYTON LUNG AND SLEEP MEDICINE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/16/2006
-----------------------------------------------------
Last Update Date | 02/17/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 120 W WENGER RD STE 1
-----------------------------------------------------
City | ENGLEWOOD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45322-2763
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-832-5292
-----------------------------------------------------
Fax | 937-832-7505
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P O BOX 634857
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45263
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-832-5292
-----------------------------------------------------
Fax | 937-832-7505
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MUSTAFA QUADRI III
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 937-832-5292
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number | 35-05-7558-Q
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------