Provider Demographics
NPI:1023091055
Name:MUTHIAH, VENKATACHALAM (MD)
Entity type:Individual
Prefix:
First Name:VENKATACHALAM
Middle Name:
Last Name:MUTHIAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7073 CLYO ROAD
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459
Mailing Address - Country:US
Mailing Address - Phone:937-435-5857
Mailing Address - Fax:937-912-4960
Practice Address - Street 1:1 ELIZABETH PL
Practice Address - Street 2:SUITE 190
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45408-1445
Practice Address - Country:US
Practice Address - Phone:937-222-3118
Practice Address - Fax:937-222-1436
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35334207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
3108215037C18OtherUNITED MINE WORKERS
310821503028OtherCARE SOURCE
OH000000004921OtherANTHEM
647579OtherATENA
OH3120003OtherUHC
390003611OtherMEDICARE RAILROAD
D35334OtherHUMANA
OH0543826Medicaid
OH0543826Medicaid
OH3120003OtherUHC
D35334OtherHUMANA