MEDICARE: AKARI TICHAVAKUNDA 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	208000000X	Pediatrics Physician	35-064983	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000133808	OTHER	OH	ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366431850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AKARI TICHAVAKUNDA M.D.

Provider Business Mailing Address
First Line	:	14100 CEDAR RD
Second Line	:	SUITE 270
City	:	CLEVELAND
State	:	OH
Zip	:	44121-3212
Country	:	US
Telephone Number	:	216-382-0555
Fax Number	:	216-382-0726

Provider Business Practice Location Address
First Line	:	14100 CEDAR RD
Second Line	:	SUITE 270
City	:	CLEVELAND
State	:	OH
Zip	:	44121-3212
Country	:	US
Telephone Number	:	216-382-0555
Fax Number	:	216-382-0726

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

Provider Enumeration Date	:	10/18/2005
Last Update Date	:	02/19/2016

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