Provider Demographics
NPI:1881887974
Name:A R SRIKANTIAH MD INC
Entity type:Organization
Organization Name:A R SRIKANTIAH MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AKKIHEBBAL
Authorized Official - Middle Name:R
Authorized Official - Last Name:SRIKANTIAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-432-7319
Mailing Address - Street 1:9884 CADIZ RD
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-9633
Mailing Address - Country:US
Mailing Address - Phone:740-432-7319
Mailing Address - Fax:740-432-7310
Practice Address - Street 1:9884 CADIZ RD
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-9633
Practice Address - Country:US
Practice Address - Phone:740-432-7319
Practice Address - Fax:740-432-7310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35040065207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0316518Medicaid
000000118077OtherANTHEM
000000118077OtherANTHEM
=========00OtherWORKERS COMPENSATION
9230382Medicare PIN
OH0316518Medicaid