Provider Demographics
NPI:1548240286
Name:KEDIA, KAILASH R I (MD)
Entity Type:Individual
Prefix:
First Name:KAILASH
Middle Name:R
Last Name:KEDIA
Suffix:I
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 1:19250 BAGLEY RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:MIDDLEBURG HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-3314
Mailing Address - Country:US
Mailing Address - Phone:440-891-6500
Mailing Address - Fax:440-891-1196
Practice Address - Street 1:19250 BAGLEY RD
Practice Address - Street 2:SUITE 107
Practice Address - City:MIDDLEBURG HTS
Practice Address - State:OH
Practice Address - Zip Code:44130-3314
Practice Address - Country:US
Practice Address - Phone:440-891-6500
Practice Address - Fax:440-891-1196
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH039656174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0349260Medicaid
OH0430989Medicare PIN
OH0349260Medicaid