Provider Demographics
NPI:1750368130
Name:PALLAPOTHU, SUKESHINI R (MD)
Entity type:Individual
Prefix:DR
First Name:SUKESHINI
Middle Name:R
Last Name:PALLAPOTHU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 BUCHANAN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-4749
Mailing Address - Country:US
Mailing Address - Phone:419-621-8330
Mailing Address - Fax:419-621-8325
Practice Address - Street 1:540 BUCHANAN ST
Practice Address - Street 2:SUITE C
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-4749
Practice Address - Country:US
Practice Address - Phone:419-621-8330
Practice Address - Fax:419-621-8325
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-04-9610P208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0520814Medicaid
OH0520814Medicaid
OHPA0535431Medicare PIN