Provider Demographics
NPI:1639193667
Name:NAKANISHI, ERIC H (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:H
Last Name:NAKANISHI
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 1:3605 WARRENSVILLE CENTER RD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5203
Mailing Address - Country:US
Mailing Address - Phone:216-286-6260
Mailing Address - Fax:216-286-6341
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-7330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-063426207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0882120Medicaid
OHP00383077OtherMEDICARE RAILROAD
OH0988436Medicaid
OH000000209122OtherUNISON
OH000000503572OtherANTHEM
OH4616193OtherAETNA
OH000000516052OtherANTHEM
OH221147OtherUNISON
OHP00364277OtherRAILROAD MEDICARE
OH000000503572OtherANTHEM
OH221147OtherUNISON
F80360Medicare UPIN
OHNA0762035Medicare PIN