Individual
PETER BAMBAKIDIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
25200 CENTER RIDGE RD, STE 2100, WESTLAKE, OH 44145
(440) 331-4053
(440) 331-4073
Mailing address
20525 CENTER RIDGE RD, STE 220, ROCKY RIVER, OH 44116
(440) 895-5056
(440) 333-2935
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
35058627B
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000246863
ANTHEM
—
01
—
0119204
GROUP MEDICAID
—
01
—
0501061
UNITED HEALTHCARE
—
05
—
0749284
—
OH
01
—
102920
KAISER
—
01
—
10788157
CAQH
—
01
—
1780634279
GROUP NPI
—
01
—
341783789093
CARESOURCE
—
01
—
3610861
GROUP ASC MEDICARE
—
01
—
4117752
AETNA
—
01
—
9273172
GROUP MEDICARE
—
01
—
CA4511
GROUP RR MEDICARE
—
01
—
D3683041
GROUP IND DIAGNOSTICS MED
—
01
—
F58622
SUMMACARE APEX
—
Enumeration date
02/23/2006
Last updated
05/27/2008
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