Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 35128080 | OH |
NPI | 1174878615 |
---|---|
Provider Name | Dr. Suman Vellanki |
First Address | Akron, OH 44304-1619 |
Second Address | Akron, OH 44310-3110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2012 |
Last Update Date | 18/09/2017 |