Provider Demographics
NPI:1356485486
Name:KRUTI INTERNAL MEDICINE
Entity Type:Organization
Organization Name:KRUTI INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRUTI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-502-2194
Mailing Address - Street 1:1724 DAFFODIL TRL
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-5210
Mailing Address - Country:US
Mailing Address - Phone:330-502-2194
Mailing Address - Fax:
Practice Address - Street 1:1724 DAFFODIL TRL
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:OH
Practice Address - Zip Code:44514-5210
Practice Address - Country:US
Practice Address - Phone:330-502-2194
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2521944Medicaid
9349561Medicare ID - Type UnspecifiedMEDICARE GROUP #
OH2521944Medicaid