MEDICARE: BEENA SREEKUMAR 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	35.087223	OH
2	207R00000X	Internal Medicine Physician	35087223	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073503645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEENA SREEKUMAR MD

Provider Business Mailing Address
First Line	:	PO BOX 8792
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-8792
Country	:	US
Telephone Number	:	440-582-9600
Fax Number	:	440-582-5492

Provider Business Practice Location Address
First Line	:	14200 RIDGE RD
Second Line	:
City	:	N ROYALTON
State	:	OH
Zip	:	44133-4972
Country	:	US
Telephone Number	:	440-582-9600
Fax Number	:	440-582-5492

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

Provider Enumeration Date	:	10/25/2005
Last Update Date	:	11/18/2020

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Directions to “ BEENA SREEKUMAR MD” Practice Location

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