Provider Demographics
NPI:1225092521
Name:KHANDEKAR, RAHUL P (DPM)
Entity Type:Individual
Prefix:
First Name:RAHUL
Middle Name:P
Last Name:KHANDEKAR
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24701 EUCLID AVE
Mailing Address - Street 2:THIRD FLOOR BILLING SERVICES
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:330-923-0553
Mailing Address - Fax:330-923-0556
Practice Address - Street 1:96 GRAHAM RD
Practice Address - Street 2:SUITE B
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223-1205
Practice Address - Country:US
Practice Address - Phone:330-923-0553
Practice Address - Fax:330-923-0556
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-003094213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2152110Medicaid
OH5199110001OtherDMERC
OH5199110001OtherDMERC
OHKH4027531Medicare PIN