Provider Demographics
NPI:1659877652
Name:PADIADPU, ANISH BHAT (MBBS (EQUIVALENT)
Entity Type:Individual
Prefix:DR
First Name:ANISH
Middle Name:BHAT
Last Name:PADIADPU
Suffix:
Gender:M
Credentials:MBBS (EQUIVALENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 E 13TH ST APT 11W
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44114-3217
Mailing Address - Country:US
Mailing Address - Phone:949-439-7910
Mailing Address - Fax:
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:949-439-7910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-30
Last Update Date:2019-07-03
Deactivation Date:2018-11-01
Deactivation Code:
Reactivation Date:2018-11-15
Provider Licenses
StateLicense IDTaxonomies
FLTRN27082390200000X
390200000X
OH248490390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0355160Medicaid