Provider Demographics
NPI:1194945956
Name:E.W. UNNIKRISHNAN M.D. PSC
Entity type:Organization
Organization Name:E.W. UNNIKRISHNAN M.D. PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:E.W
Authorized Official - Middle Name:
Authorized Official - Last Name:UNNIKRISHNAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-836-2311
Mailing Address - Street 1:900 ST CHRISTOPHER DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101
Mailing Address - Country:US
Mailing Address - Phone:606-836-2311
Mailing Address - Fax:606-836-3616
Practice Address - Street 1:900 SAINT CHRISTOPHER DR
Practice Address - Street 2:SUITE 201
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7090
Practice Address - Country:US
Practice Address - Phone:606-836-2311
Practice Address - Fax:606-836-3616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY19376208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64193766Medicaid
KY000000047124OtherANTHEM BC AND BS
OH0398976Medicaid
KS408013656Medicare ID - Type UnspecifiedRAILROAD MEDICARE
KY1005801Medicare ID - Type Unspecified
OH0398976Medicaid