=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881887974
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A R SRIKANTIAH MD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2007
-----------------------------------------------------
Last Update Date | 10/20/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9884 CADIZ RD
-----------------------------------------------------
City | CAMBRIDGE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43725-9633
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-432-7319
-----------------------------------------------------
Fax | 740-432-7310
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9884 CADIZ RD
-----------------------------------------------------
City | CAMBRIDGE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43725-9633
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-432-7319
-----------------------------------------------------
Fax | 740-432-7310
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. AKKIHEBBAL R SRIKANTIAH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 740-432-7319
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | 35040065
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------