MEDICARE: LOKESH B NINGEGOWDA MD LLC

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	35.087755	OH
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	35.087755	OH

General Provider Information

NPI Number	:	1972906634
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOKESH B NINGEGOWDA MD LLC

Provider Business Mailing Address
First Line	:	588 EMERALD CT
Second Line	:
City	:	AURORA
State	:	OH
Zip	:	44202-7869
Country	:	US
Telephone Number	:	216-229-0781
Fax Number	:

Provider Business Practice Location Address
First Line	:	5311 NORTHFIELD RD
Second Line	:	SUITE 308
City	:	BEDFORD
State	:	OH
Zip	:	44146-1188
Country	:	US
Telephone Number	:	216-577-0224
Fax Number	:	216-663-5006

Authorized Official
Title or Position	:	OWNER
Name	:	DR. LOKESH B NINGEGOWDA
Credential	:	M.D
Telephone Number	:	216-229-0781

Provider Enumeration Date	:	10/08/2014
Last Update Date	:	10/10/2014

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