Provider Demographics
NPI:1841245925
Name:HEALTH SPECIALISTS OF DAYTON INC
Entity Type:Organization
Organization Name:HEALTH SPECIALISTS OF DAYTON INC
Other - Org Name:DHEEPA BALAKRISHNAN MD COMPANY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:PRUNIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-208-8213
Mailing Address - Street 1:1 WYOMING ST
Mailing Address - Street 2:STE 3110 BERRY PAVILION
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409-2722
Mailing Address - Country:US
Mailing Address - Phone:937-208-6800
Mailing Address - Fax:937-208-2139
Practice Address - Street 1:1 WYOMING ST
Practice Address - Street 2:STE 3110 BERRY PAVILION
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-2722
Practice Address - Country:US
Practice Address - Phone:937-208-6800
Practice Address - Fax:937-208-2139
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTH SPECIALISTS OF DAYTON INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-24
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2584038Medicaid
9353864Medicare PIN