MEDICARE: DR. INNA KRASNYANSKY M.D.

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	35076087	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2316224	OTHER	OH	AETNA-LIFE & CASUALTY
2	000000142148	OTHER	OH	UNICARE-LIFE & HEALTH
3	000000142148	OTHER	OH	ANTHEM BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053312298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. INNA KRASNYANSKY M.D.

Provider Business Mailing Address
First Line	:	6803 MAYFIELD RD
Second Line	:	STE 409 BLDG 1
City	:	MAYFIELD HTS
State	:	OH
Zip	:	44124
Country	:	US
Telephone Number	:	440-946-4662
Fax Number	:	440-946-4084

Provider Business Practice Location Address
First Line	:	36100 EUCLID AVE STE 409
Second Line	:
City	:	WILLOUGHBY
State	:	OH
Zip	:	44094-4456
Country	:	US
Telephone Number	:	440-946-4662
Fax Number	:

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

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	07/23/2024

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