Provider Demographics
NPI:1598764391
Name:CARDIOLOGY SPECIALISTS OF DAYTON INC.
Entity Type:Organization
Organization Name:CARDIOLOGY SPECIALISTS OF DAYTON INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:BULOW
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:937-454-9527
Mailing Address - Street 1:4160 LITTLE YORK RD
Mailing Address - Street 2:STE. 20
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45414-5800
Mailing Address - Country:US
Mailing Address - Phone:937-454-9527
Mailing Address - Fax:937-454-9532
Practice Address - Street 1:4160 LITTLE YORK RD
Practice Address - Street 2:STE. 20
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45414-5800
Practice Address - Country:US
Practice Address - Phone:937-454-9527
Practice Address - Fax:937-454-9532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-14
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006383207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0918449Medicaid
OHCL4019OtherRAILROAD MEDICARE
OH=========005OtherTRICARE
OHCL4019OtherRAILROAD MEDICARE
OHCL4019OtherRAILROAD MEDICARE