Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 35-081374 | OH |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 35-081374 | OH |
N | 207RC0001X | Clinical Cardiac Electrophysiologist | 35.081374 | OH |
NPI | 1083639546 |
---|---|
Provider Name | Ivan T Cakulev |
First Address | Euclid, OH 44117-1714 |
Second Address | Cleveland, OH 44106-1716 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 14/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000224440 | UNISON (01) | |
000000539491 | ANTHEM (01) | |
2523111 | (05) | OH |
363391 | WELLCARE (01) | |
734681 | BUCKEYE (01) | |
7598674 | AETNA (01) | OH |
I23792 | (02) | |
P00226315 | RAILROAD MEDICARE (01) | OH |
P00428927 | RAILROAD MEDICARE (01) | OH |