Provider Demographics
NPI:1134288160
Name:DRS. DESHMUKH & CICHOCKI, INC.
Entity Type:Organization
Organization Name:DRS. DESHMUKH & CICHOCKI, INC.
Other - Org Name:DR. AVINASH S. DESHMUKH, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AVINASH
Authorized Official - Middle Name:S
Authorized Official - Last Name:DESHMUKH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-893-0902
Mailing Address - Street 1:7550 LUCERNE DR
Mailing Address - Street 2:SUITE 405
Mailing Address - City:MIDDLEBURG HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-6588
Mailing Address - Country:US
Mailing Address - Phone:440-234-8833
Mailing Address - Fax:440-234-3313
Practice Address - Street 1:5705 MONCLOVA RD
Practice Address - Street 2:SUITE 202
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-1875
Practice Address - Country:US
Practice Address - Phone:419-893-0902
Practice Address - Fax:419-891-0152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0441141Medicaid
OH9174091Medicare PIN