| Vijay Kakumanu Md Llc | |
|
4036 Center Rd Unit B Brunswick OH 44212-2945 | |
| (330) 225-7733 | |
| (330) 220-0902 |
| Full Name | Vijay Kakumanu Md Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 4036 Center Rd Unit B, Brunswick, Ohio |
| Authorized Official Name and Position | Vijay Kakumanu (CEO) |
| Authorized Official Contact | 4403714024 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vijay Kakumanu Md Llc 4036 Center Rd Unit B Brunswick OH 44212-2945 Ph: (330) 225-7733 | Vijay Kakumanu Md Llc 4036 Center Rd Unit B Brunswick OH 44212-2945 Ph: (330) 225-7733 |
| NPI Number | 1780229435 |
|---|---|
| Provider Enumeration Date | 11/16/2019 |
| Last Update Date | 11/16/2019 |
| Medicare PECOS PAC ID | 8820422504 |
|---|---|
| Medicare Enrollment ID | O20200106002114 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780229435 | NPI | - | NPPES |
| 2903960 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Vijay Kakumanu |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1225225816 PECOS PAC ID: 8921164146 Enrollment ID: I20090312000518 |
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