MEDICARE: VENKATACHALAM MUTHIAH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	35334	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	390003611	OTHER		MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3108215037C18	OTHER		UNITED MINE WORKERS
2	310821503028	OTHER		CARE SOURCE
3	000000004921	OTHER	OH	ANTHEM
4	647579	OTHER		ATENA
5	3120003	OTHER	OH	UHC
7	D35334	OTHER		HUMANA
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023091055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VENKATACHALAM MUTHIAH MD

Provider Business Mailing Address
First Line	:	7073 CLYO ROAD
Second Line	:
City	:	CENTERVILLE
State	:	OH
Zip	:	45459
Country	:	US
Telephone Number	:	937-435-5857
Fax Number	:	937-912-4960

Provider Business Practice Location Address
First Line	:	1 ELIZABETH PL
Second Line	:	SUITE 190
City	:	DAYTON
State	:	OH
Zip	:	45408-1445
Country	:	US
Telephone Number	:	937-222-3118
Fax Number	:	937-222-1436

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/23/2005
Last Update Date	:	04/28/2010

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Directions to “ VENKATACHALAM MUTHIAH MD” Practice Location

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