Provider Demographics
NPI:1225225816
Name:KAKUMANU, VIJAY (MD)
Entity type:Individual
Prefix:DR
First Name:VIJAY
Middle Name:
Last Name:KAKUMANU
Suffix:
Gender:
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:PO BOX 636643
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6643
Mailing Address - Country:US
Mailing Address - Phone:440-988-1009
Mailing Address - Fax:440-988-1227
Practice Address - Street 1:630 E RIVER ST
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-5902
Practice Address - Country:US
Practice Address - Phone:440-988-1009
Practice Address - Fax:440-960-1227
Is Sole Proprietor?:No
Enumeration Date:2007-09-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61664572207R00000X
OH57.010735390200000X
OH35.092595207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2903960Medicaid
OH3025372Medicaid
OH3025372Medicaid
OH9389631Medicare PIN