Provider Demographics
NPI:1801891007
Name:DESHPANDE, KEDAR KRISHNA (MD)
Entity type:Individual
Prefix:
First Name:KEDAR
Middle Name:KRISHNA
Last Name:DESHPANDE
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 1:453 ALLENBY DR
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-8722
Mailing Address - Country:US
Mailing Address - Phone:937-738-2732
Mailing Address - Fax:937-738-2514
Practice Address - Street 1:453 ALLENBY DR
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-8722
Practice Address - Country:US
Practice Address - Phone:937-738-2732
Practice Address - Fax:937-738-2514
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-08-0539-D208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2466273Medicaid
OHDE4130091Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE #
H73716Medicare UPIN