Healthcare Provider Details

I. General information

NPI: 1831178110
Provider Name (Legal Business Name): RAJEEV KISHORE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 09/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PERKINS SQ
AKRON OH
44308-1063
US

IV. Provider business mailing address

1 PERKINS SQ
AKRON OH
44308-1063
US

V. Phone/Fax

Practice location:
  • Phone: 330-543-0140
  • Fax: 330-543-5207
Mailing address:
  • Phone: 330-543-0140
  • Fax: 330-543-5207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number35041932K
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: