Provider Demographics
NPI:1700833837
Name:DONTHI, KIRAN R (MD)
Entity Type:Individual
Prefix:
First Name:KIRAN
Middle Name:R
Last Name:DONTHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:275 GRAHAM RD
Mailing Address - Street 2:STE 2
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223-2259
Mailing Address - Country:US
Mailing Address - Phone:330-923-5123
Mailing Address - Fax:330-923-6654
Practice Address - Street 1:275 GRAHAM RD
Practice Address - Street 2:STE 2
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223-2259
Practice Address - Country:US
Practice Address - Phone:330-923-5123
Practice Address - Fax:330-923-6654
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35042811207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0417454Medicaid
OHH432140Medicare PIN
OH0417454Medicaid
D00482542Medicare PIN