Provider Demographics
NPI:1366431850
Name:TICHAVAKUNDA, AKARI (MD)
Entity type:Individual
Prefix:
First Name:AKARI
Middle Name:
Last Name:TICHAVAKUNDA
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 1:14100 CEDAR RD
Mailing Address - Street 2:SUITE 270
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44121-3212
Mailing Address - Country:US
Mailing Address - Phone:216-382-0555
Mailing Address - Fax:216-382-0726
Practice Address - Street 1:14100 CEDAR RD
Practice Address - Street 2:SUITE 270
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44121-3212
Practice Address - Country:US
Practice Address - Phone:216-382-0555
Practice Address - Fax:216-382-0726
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-064983208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000133808OtherANTHEM
OH0929740Medicaid
OHF68778Medicare UPIN