Healthcare Provider Details

I. General information

NPI: 1215270343
Provider Name (Legal Business Name): SUNEEL DEEPAK KAMATH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2013
Last Update Date: 07/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10201 CARNEGIE AVE
CLEVELAND OH
44106-2130
US

IV. Provider business mailing address

441 E ERIE ST APT 5705
CHICAGO IL
60611-7155
US

V. Phone/Fax

Practice location:
  • Phone: 866-223-8100
  • Fax:
Mailing address:
  • Phone: 513-319-4752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125.062618
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number35.135646
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: