Provider Demographics
NPI:1801825609
Name:MADAN MOHAN, SRI KRISHNA (MD)
Entity Type:Individual
Prefix:
First Name:SRI
Middle Name:KRISHNA
Last Name:MADAN MOHAN
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 1:8055 MAYFIELD RD STE 105
Mailing Address - Street 2:
Mailing Address - City:CHESTERLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44026-2447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
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:216-844-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35073553207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000537787OtherANTHEM NUMBER
OH000000225072OtherUNISON NUMBER
OH414785OtherAETNA NUMBER
OH496700001OtherCARESOURCE
OH81335OtherQUALCHOICE
OH5283617OtherAETNA NUMBER
OH740678OtherBUCKEYE NUMBER
OH000000305457OtherANTHEM BLUE CROSS BLUE SH
OHP73553OtherSUMMACARE
OH100656OtherKAISER
OH1765539OtherUNITED HEALTHCARE
OH2036960Medicaid
OH341487428OtherTAX ID
OHP00045244OtherRAILROAD MEDICARE
OHP00422676OtherMEDICARE RAILROAD
OHMA0837498Medicare PIN
OH000000537787OtherANTHEM NUMBER
OHG61274Medicare UPIN
OH0837496Medicare ID - Type Unspecified