Provider Demographics
NPI:1073503645
Name:SREEKUMAR, BEENA (MD)
Entity Type:Individual
Prefix:
First Name:BEENA
Middle Name:
Last Name:SREEKUMAR
Suffix:
Gender:F
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:PO BOX 8792
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-8792
Mailing Address - Country:US
Mailing Address - Phone:440-582-9600
Mailing Address - Fax:440-582-5492
Practice Address - Street 1:14200 RIDGE RD
Practice Address - Street 2:
Practice Address - City:N ROYALTON
Practice Address - State:OH
Practice Address - Zip Code:44133-4972
Practice Address - Country:US
Practice Address - Phone:440-582-9600
Practice Address - Fax:440-582-5492
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.087223207R00000X
OH35087223207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2738925Medicaid
OH2738925Medicaid