Basic Information
| Provider Information | |||||||||
| NPI: | 1487814000 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | POLURI | ||||||||
| FirstName: | ASHOK | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 229 | ||||||||
| Address2: | |||||||||
| City: | MIAMISBURG | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453430229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138740486 | ||||||||
| FaxNumber: | 5132808868 | ||||||||
| Practice Location | |||||||||
| Address1: | 6730 ROOSEVELT AVE STE 303 | ||||||||
| Address2: | |||||||||
| City: | MIDDLETOWN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450050017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138740486 | ||||||||
| FaxNumber: | 5132808868 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2008 | ||||||||
| LastUpdateDate: | 04/19/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 35-124217 | OH | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 208VP0000X | 35-124217 | OH | N | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | 208100000X | 47220 | KY | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 208VP0000X | 47220 | KY | N | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | 208M00000X | 47220 | KY | Y | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | 35-124217 | OH | N | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 0110987 | 05 | OH | MEDICAID | 7100319030 | 05 | KY | MEDICAID |