MEDICARE: MRS. ESTHER GRACE PABLO KANAYJORN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	35077853-K	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	363844	OTHER	OH	RHC MEDICARE FACILITY #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	2122096001	OTHER	OH	CIGNA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	7724279	OTHER	OH	AETNA
5	000000184923	OTHER	OH	ANTHEM BC/BS
6	0401451	OTHER	OH	UNITED HEALTH CARE
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043202187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ESTHER GRACE PABLO KANAYJORN MD

Provider Business Mailing Address
First Line	:	104 ERIN COURT
Second Line	:
City	:	HILLSBORO
State	:	OH
Zip	:	45133-0070
Country	:	US
Telephone Number	:	937-393-5781
Fax Number	:	937-393-5784

Provider Business Practice Location Address
First Line	:	1092 JEFFERSON ST
Second Line	:
City	:	GREENFIELD
State	:	OH
Zip	:	45123-8319
Country	:	US
Telephone Number	:	937-981-1121
Fax Number	:	937-981-5660

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	02/19/2008

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Directions to “ MRS. ESTHER GRACE PABLO KANAYJORN MD” Practice Location

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