Provider Demographics
NPI:1700346814
Name:PANNIKOTTU, JEAN MARY (MD)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:MARY
Last Name:PANNIKOTTU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3219 CLIFTON AVE STE 225
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45220-3043
Mailing Address - Country:US
Mailing Address - Phone:513-624-0999
Mailing Address - Fax:513-624-0934
Practice Address - Street 1:3219 CLIFTON AVE STE 225
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45220-3043
Practice Address - Country:US
Practice Address - Phone:513-624-0999
Practice Address - Fax:513-624-0934
Is Sole Proprietor?:No
Enumeration Date:2019-03-23
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.145312207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease