Provider Demographics
NPI:1760684682
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:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BULOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-434-3968
Mailing Address - Street 1:PO BOX 634766
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-0042
Mailing Address - Country:US
Mailing Address - Phone:800-611-6912
Mailing Address - Fax:440-716-1605
Practice Address - Street 1:1512 YANKEE PARK PL
Practice Address - Street 2:
Practice Address - City:CENTERVILLE FINANCE
Practice Address - State:OH
Practice Address - Zip Code:45458-1878
Practice Address - Country:US
Practice Address - Phone:937-434-3968
Practice Address - Fax:937-434-4886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0918449Medicaid
OHCL4019OtherRAILROAD MEDICARE B
OH=========04OtherBWC
OHCL4019OtherRAILROAD MEDICARE B
OH=========002OtherTRICARE