Healthcare Provider Details

I. General information

NPI: 1679968457
Provider Name (Legal Business Name): ANUSHA ANUKANTH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2015
Last Update Date: 01/24/2023
Certification Date: 01/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVENUE ML 7015
CINCINNATI OH
45229
US

IV. Provider business mailing address

7503 S TIMBERLANE DR
MADEIRA OH
45243-1847
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4266
  • Fax: 513-636-3549
Mailing address:
  • Phone: 617-515-6605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number35.136313
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: