Provider Demographics
NPI:1528087160
Name:KANNAPIRAN, KANDHASAMY (MD;)
Entity type:Individual
Prefix:DR
First Name:KANDHASAMY
Middle Name:
Last Name:KANNAPIRAN
Suffix:
Gender:M
Credentials:MD;
Other - Prefix:DR
Other - First Name:KANDHASAMY
Other - Middle Name:
Other - Last Name:KANNAPIRAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD;
Mailing Address - Street 1:339 CLINE AVE
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44907-1072
Mailing Address - Country:US
Mailing Address - Phone:419-756-1242
Mailing Address - Fax:419-756-7894
Practice Address - Street 1:339 CLINE AVE
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44907-1072
Practice Address - Country:US
Practice Address - Phone:419-756-1242
Practice Address - Fax:419-756-7894
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350 48702207R00000X
KY39896207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0517631Medicaid
OHA80586Medicare ID - Type Unspecified
OH0517631Medicaid