Provider Demographics
NPI:1295757755
Name:ZAHKA, KENNETH G (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:G
Last Name:ZAHKA
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 1:9500 EUCLID AVE
Mailing Address - Street 2:ST10
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:440-878-2500
Mailing Address - Fax:
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:ST10
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:440-878-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-059961207RA0002X, 2080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No207RA0002XAllopathic & Osteopathic PhysiciansInternal MedicineAdult Congenital Heart Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000217368OtherUNISON
OH000000526177OtherANTHEM
OH0647550OtherAETNA
OH0791675OtherBCMH
OK200206580AOtherOK MEDICAID
PA0013019200003Medicaid
OH0791675Medicaid
OH727590OtherBUCKEYE
OH00000027997OtherANTHEM
OH364162OtherWELLCARE
OHP00600871OtherRAILROAD MEDICARE
OH0791675Medicaid
OHZA0675543Medicare PIN
OHZA0675541Medicare PIN
OH7322052Medicare PIN