Provider Demographics
NPI:1265405013
Name:MOHAN R NUTHAKKI MD & ASSOC INC
Entity type:Organization
Organization Name:MOHAN R NUTHAKKI MD & ASSOC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOHAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:NUTHAKKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-440-4210
Mailing Address - Street 1:PO BOX 712274
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45271-2274
Mailing Address - Country:US
Mailing Address - Phone:937-440-4210
Mailing Address - Fax:937-440-4211
Practice Address - Street 1:3130 N DIXIE HWY
Practice Address - Street 2:SUITE 107
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373
Practice Address - Country:US
Practice Address - Phone:937-440-4210
Practice Address - Fax:937-440-4211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-10
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2342281Medicaid
OH4603030001Medicare NSC
H67557Medicare UPIN
OH9282783Medicare PIN