Provider Demographics
NPI:1417364712
Name:MITTAL, TARUN
Entity type:Individual
Prefix:
First Name:TARUN
Middle Name:
Last Name:MITTAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIV OF CINCINNATI DIVISION OF NEPHROLOGY
Mailing Address - Street 2:231 ALBERT SABIN WAY
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45267-0585
Mailing Address - Country:US
Mailing Address - Phone:248-971-4322
Mailing Address - Fax:
Practice Address - Street 1:UNIV OF CINCINNATI DIVISION OF NEPHROLOGY
Practice Address - Street 2:231 ALBERT SABIN WAY
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45267-0585
Practice Address - Country:US
Practice Address - Phone:248-971-4322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-18
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57-024031207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology