MEDICARE: DAYTON COLON RECTAL CENTER, INC.

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	208C00000X	Colon & Rectal Surgery Physician

General Provider Information

NPI Number	:	1245286715
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAYTON COLON RECTAL CENTER, INC.

Provider Business Mailing Address
First Line	:	5932 SPRINGBORO PIKE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45449-3250
Country	:	US
Telephone Number	:	937-435-8663
Fax Number	:	937-435-8966

Provider Business Practice Location Address
First Line	:	5932 SPRINGBORO PIKE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45449-3250
Country	:	US
Telephone Number	:	937-435-8663
Fax Number	:	937-435-8966

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DEEPAK KUMAR
Credential	:	M.D.
Telephone Number	:	937-435-8663

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	10/10/2011

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