Individual
DR. BASAVARAJAPPA VISWANATH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
125 E BROAD ST, SUITE #209, ELYRIA, OH 44035-6400
(440) 329-7320
(440) 329-7319
Mailing address
24701 EUCLID AVE, THIRD FLOOR BILLING SERVICES, EUCLID, OH 44117-1714
(440) 329-7320
(440) 329-7319
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35-044261
OH
208D00000X
General Practice Physician
35-044261
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0429478
—
OH
01
—
080117615
RAILROAD MEDICARE
—
Enumeration date
12/30/2005
Last updated
12/14/2020
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