MEDICARE: DR. MOHAN Y. KARETI 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	207L00000X	Anesthesiology Physician	35076522	OH
2	208VP0000X	Pain Medicine Physician	35-076522	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
2	4157017	OTHER	OH	PTAN

General Provider Information

NPI Number	:	1740221605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOHAN Y. KARETI M.D.

Provider Business Mailing Address
First Line	:	805 E WASHINGTON ST STE 120
Second Line	:
City	:	MEDINA
State	:	OH
Zip	:	44256-3331
Country	:	US
Telephone Number	:	330-721-4477
Fax Number	:	330-721-4466

Provider Business Practice Location Address
First Line	:	805 E WASHINGTON ST STE 120
Second Line	:
City	:	MEDINA
State	:	OH
Zip	:	44256-3331
Country	:	US
Telephone Number	:	330-721-4477
Fax Number	:	330-721-4466

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

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	09/10/2015

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