Provider Demographics
NPI:1568160208
Name:DAYTON ENDOVASCULAR CENTER, LLC
Entity Type:Organization
Organization Name:DAYTON ENDOVASCULAR CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAMAL
Authorized Official - Middle Name:
Authorized Official - Last Name:MORAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-479-6070
Mailing Address - Street 1:938 OLDE STERLING WAY
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-3100
Mailing Address - Country:US
Mailing Address - Phone:513-773-3455
Mailing Address - Fax:513-773-3465
Practice Address - Street 1:3075 GOVERNORS PLACE BLVD STE 120
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-1332
Practice Address - Country:US
Practice Address - Phone:513-773-3455
Practice Address - Fax:513-773-3465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-22
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty