Provider Demographics
NPI:1285609370
Name:AKUTHOTA, PANI SARANGA (MD, FAAEM)
Entity type:Individual
Prefix:
First Name:PANI
Middle Name:SARANGA
Last Name:AKUTHOTA
Suffix:
Gender:M
Credentials:MD, FAAEM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45415-1180
Mailing Address - Country:US
Mailing Address - Phone:937-298-5536
Mailing Address - Fax:937-276-8223
Practice Address - Street 1:9000 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:OH
Practice Address - Zip Code:45415-1180
Practice Address - Country:US
Practice Address - Phone:937-298-5536
Practice Address - Fax:937-276-8223
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH06151052081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0615105Medicaid
OH250006022OtherMEDICARE ID
OHA16332Medicare UPIN
OH250006022OtherMEDICARE ID
OHAK0578851Medicare PIN