Provider Demographics
NPI:1568692655
Name:PILLAI, KANCHAN M (MD)
Entity Type:Individual
Prefix:
First Name:KANCHAN
Middle Name:M
Last Name:PILLAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KANCHAN
Other - Middle Name:V
Other - Last Name:LANDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:333 N SUMMIT ST FL 7
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1531
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6175 LEVIS COMMONS BLVD STE 104
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-7269
Practice Address - Country:US
Practice Address - Phone:567-585-0380
Practice Address - Fax:567-585-0381
Is Sole Proprietor?:No
Enumeration Date:2009-07-23
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35099555207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0069201Medicaid
OH35099555OtherOHIO MEDICAL LICENSE
OH0069201Medicaid