Provider Demographics
NPI:1467626549
Name:TANDON, ANIMESH (MD, MS)
Entity Type:Individual
Prefix:MR
First Name:ANIMESH
Middle Name:
Last Name:TANDON
Suffix:
Gender:M
Credentials:MD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 EUCLID AVE # M41
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:216-445-7144
Mailing Address - Fax:164-453-6922
Practice Address - Street 1:9500 EUCLID AVE # M41
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-7208
Practice Address - Country:US
Practice Address - Phone:216-445-7144
Practice Address - Fax:216-445-3692
Is Sole Proprietor?:No
Enumeration Date:2008-04-18
Last Update Date:2021-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ51072080P0202X
390200000X
OH35 0949722080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program