Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 35090803 | OH |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | PENDING | OH |
NPI | 1275531899 |
---|---|
Provider Name | Indiresha Ramachandra Iyer |
First Address | Akron, OH 44302-1726 |
Second Address | Akron, OH 44302-1726 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2005 |
Last Update Date | 14/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000292339 | ANTHEM BLUE CROSS (01) | KY |
000000731990 | ANTHEM (01) | OH |
2437081 | (05) | OH |
64068323 | (05) | KY |
H81791 | (02) | KY |