Provider Demographics
NPI:1639419062
Name:SARAVANAN LLC
Entity Type:Organization
Organization Name:SARAVANAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BALAJI
Authorized Official - Middle Name:
Authorized Official - Last Name:SARAVANAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-352-4321
Mailing Address - Street 1:PO BOX 477
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-0477
Mailing Address - Country:US
Mailing Address - Phone:440-352-4321
Mailing Address - Fax:440-392-6193
Practice Address - Street 1:630 E RIVER ST
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-5902
Practice Address - Country:US
Practice Address - Phone:440-352-4321
Practice Address - Fax:440-392-6193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-21
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2776509Medicaid
OH2776509Medicaid