MEDICARE: EDAKKUNNY W UNNIKRISHNAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	19376	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326023110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDAKKUNNY W UNNIKRISHNAN MD

Provider Business Mailing Address
First Line	:	900 SAINT CHRISTOPHER DR
Second Line	:	SUITE 201
City	:	ASHLAND
State	:	KY
Zip	:	41101-7032
Country	:	US
Telephone Number	:	606-836-2311
Fax Number	:	606-836-3616

Provider Business Practice Location Address
First Line	:	900 SAINT CHRISTOPHER DR
Second Line	:	SUITE 201
City	:	ASHLAND
State	:	KY
Zip	:	41101-7032
Country	:	US
Telephone Number	:	606-836-2311
Fax Number	:	606-836-3616

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	03/01/2012

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