Provider Demographics
NPI:1457790941
Name:CINCINNATI PAIN PHYSICIANS LLC
Entity type:Organization
Organization Name:CINCINNATI PAIN PHYSICIANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GURURAU
Authorized Official - Middle Name:
Authorized Official - Last Name:SUDARSHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-673-9612
Mailing Address - Street 1:8261 CORNELL RD
Mailing Address - Street 2:# 630
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45249-2278
Mailing Address - Country:US
Mailing Address - Phone:513-891-0022
Mailing Address - Fax:513-672-0830
Practice Address - Street 1:8261 CORNELL RD
Practice Address - Street 2:# 630
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249-2278
Practice Address - Country:US
Practice Address - Phone:513-891-0022
Practice Address - Fax:513-672-0830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-18
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2199579208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty