Provider Demographics
NPI:1326023110
Name:UNNIKRISHNAN, EDAKKUNNY W (MD)
Entity Type:Individual
Prefix:
First Name:EDAKKUNNY
Middle Name:W
Last Name:UNNIKRISHNAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 SAINT CHRISTOPHER DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-7032
Mailing Address - Country:US
Mailing Address - Phone:606-836-2311
Mailing Address - Fax:606-836-3616
Practice Address - Street 1:900 SAINT CHRISTOPHER DR
Practice Address - Street 2:SUITE 201
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7032
Practice Address - Country:US
Practice Address - Phone:606-836-2311
Practice Address - Fax:606-836-3616
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY19376208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0398976Medicaid
KY64193766Medicaid
A79825Medicare UPIN
KY64193766Medicaid