Provider Demographics
NPI:1700969797
Name:CHOKSI, KRUTARTH (MD)
Entity Type:Individual
Prefix:
First Name:KRUTARTH
Middle Name:
Last Name:CHOKSI
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 1:4974 HIGBEE AVENUE
Mailing Address - Street 2:STE 209
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2562
Mailing Address - Country:US
Mailing Address - Phone:330-493-4553
Mailing Address - Fax:330-493-3762
Practice Address - Street 1:4974 HIGBEE AVE
Practice Address - Street 2:STE 209
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2562
Practice Address - Country:US
Practice Address - Phone:330-493-4553
Practice Address - Fax:330-493-3762
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH817932084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2362812Medicaid
D83155Medicare UPIN
CH9346901Medicare ID - Type Unspecified