Provider Demographics
NPI:1942310933
Name:LOUISIN, VICTOR (MD)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:
Last Name:LOUISIN
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:PO BOX 931286
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-1494
Mailing Address - Country:US
Mailing Address - Phone:888-719-9012
Mailing Address - Fax:
Practice Address - Street 1:400 WABASH AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44307-2433
Practice Address - Country:US
Practice Address - Phone:330-364-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0303162085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000025751OtherANTHEM BC/BS
OH341046795005OtherMEDICAL MUTUAL OF OHIO
OH58042OtherQUALCHOICE
OH731514OtherBUCKEYE COMM HEALTH PLAN
OHCN1167OtherRRMC
OH0553940Medicaid
OH341046795026OtherCARESOURCE
OH731514OtherBUCKEYE COMM HEALTH PLAN
OH341046795026OtherCARESOURCE
OH341046795005OtherMEDICAL MUTUAL OF OHIO
OH4048561Medicare PIN
OHA82305Medicare UPIN
OH4048562Medicare PIN