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General NPI Number Information
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NPI Number | 1063681187
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Entity Type | Individual
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Provider Name | KETAN DEORAS M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/22/2008
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Last Update Date | 08/20/2012
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Provider Practice Location Address
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Address Line | 9500 EUCLID AVE FA20
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City | CLEVELAND
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State | OH
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Zip | 44195-0001
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Country | US
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Telephone | 216-445-7621
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Fax |
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Provider Business Mailing Address
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Address Line | 3591 N SHORE DR
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City | AKRON
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State | OH
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Zip | 44333-8331
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 82007
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 35.097819
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License Number State | OH
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