Individual
PRATHEEK SIMON KAKKASSERIL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1001 BELMONT AVE, YOUNGSTOWN, OH 44504-1003
(330) 747-1106
(330) 747-0491
Mailing address
1001 BELMONT AVE, YOUNGSTOWN, OH 44504-1003
(330) 747-1106
(330) 747-0491
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
35.120203
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0078791
—
OH
01
—
H152570
MEDICARE PTAN
OH
Enumeration date
05/28/2010
Last updated
02/25/2020
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