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General NPI Number Information
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NPI Number | 1659301844
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Entity Type | Organization
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Legal Business Name | PRAKASH K KHANDEKAR MD
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Dates
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Enumeration Date | 07/03/2006
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 6803 MAYFIELD RD 310
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City | MAYFIELD HTS
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State | OH
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Zip | 44124-2215
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Country | US
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Telephone | 440-442-3334
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Fax | 440-442-4948
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Provider Business Mailing Address
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Address Line | 6803 MAYFIELD RD 310
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City | MAYFIELD HTS
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State | OH
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Zip | 44124-2215
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Country | US
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Telephone | 440-442-3334
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Fax | 440-442-4948
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PRAKASH K. KHANDEKAR
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Credential | M.D.
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Telephone | 440-442-3334
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 35.033148
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License Number State | OH
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