Provider Demographics
NPI:1477552271
Name:BULOW, ROBERT E (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:BULOW
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3170 KETTERING BLVD BLDG B3
Mailing Address - Street 2:
Mailing Address - City:MORAINE
Mailing Address - State:OH
Mailing Address - Zip Code:45439-1924
Mailing Address - Country:US
Mailing Address - Phone:937-991-3188
Mailing Address - Fax:937-223-9811
Practice Address - Street 1:2350 MIAMI VALLEY DR STE 310
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-4778
Practice Address - Country:US
Practice Address - Phone:937-438-5216
Practice Address - Fax:937-438-5229
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006383207RC0000X, 207RI0011X, 207UN0901X, 207RC0001X
OH34.006383207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000009508OtherANTHEM
OHP00922092OtherRAILROAD MEDICARE PIN
OH0234517Medicaid
OH4126541Medicare PIN
OHP00922092OtherRAILROAD MEDICARE PIN
OH4126543Medicare PIN