MEDICARE: CARDIOLOGY SPECIALISTS OF DAYTON 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	207RC0000X	Cardiovascular Disease Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CL4019	OTHER	OH	RAILROAD MEDICARE B

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760684682
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDIOLOGY SPECIALISTS OF DAYTON INC

Provider Business Mailing Address
First Line	:	PO BOX 634766
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-0042
Country	:	US
Telephone Number	:	800-611-6912
Fax Number	:	440-716-1605

Provider Business Practice Location Address
First Line	:	1512 YANKEE PARK PL
Second Line	:
City	:	CENTERVILLE FINANCE
State	:	OH
Zip	:	45458-1878
Country	:	US
Telephone Number	:	937-434-3968
Fax Number	:	937-434-4886

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROBERT BULOW
Credential	:	MD
Telephone Number	:	937-434-3968

Provider Enumeration Date	:	06/04/2007
Last Update Date	:	04/20/2008

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