Provider Demographics
NPI:1194781500
Name:BEKENY, JAMES R (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:BEKENY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 COLUMBIA RD
Mailing Address - Street 2:202
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-1493
Mailing Address - Country:US
Mailing Address - Phone:440-899-4646
Mailing Address - Fax:440-899-4648
Practice Address - Street 1:850 COLUMBIA RD
Practice Address - Street 2:202
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-1493
Practice Address - Country:US
Practice Address - Phone:440-899-4646
Practice Address - Fax:440-899-4648
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35047104174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000492826OtherANTHEM BC/BC
OH000000164089OtherANTHEM BC/BS
OH0508927Medicaid
OH341542312139OtherCARESOURCE
OHA15299Medicare UPIN
OHBE0525091Medicare PIN
OH000000164089OtherANTHEM BC/BS