Provider Demographics
NPI:1023067428
Name:PRASHANTHKUMAR, TRIKANNAD S (MD)
Entity type:Individual
Prefix:
First Name:TRIKANNAD
Middle Name:S
Last Name:PRASHANTHKUMAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 WEST MICHIGAN ST
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:OH
Mailing Address - Zip Code:45365-2401
Mailing Address - Country:US
Mailing Address - Phone:937-498-5384
Mailing Address - Fax:937-492-8093
Practice Address - Street 1:915 MICHIGAN ST STE 100
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-2401
Practice Address - Country:US
Practice Address - Phone:937-498-5384
Practice Address - Fax:937-492-8093
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-071509207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2003852Medicaid
OHG44898Medicare UPIN
OH2003852Medicaid