1295757755 NPI number — KENNETH G ZAHKA MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295757755 NPI number — KENNETH G ZAHKA MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

ZAHKA

Provider First Name:

KENNETH

Provider Middle Name:

G

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1295757755

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

11/05/2021

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

9500 EUCLID AVE

Provider Second Line Business Mailing Address:

ST10

Provider Business Mailing Address City Name:

CLEVELAND

Provider Business Mailing Address State Name:

OH

Provider Business Mailing Address Postal Code:

44195-0001

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

440-878-2500

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

9500 EUCLID AVE

Provider Second Line Business Practice Location Address:

ST10

Provider Business Practice Location Address City Name:

CLEVELAND

Provider Business Practice Location Address State Name:

OH

Provider Business Practice Location Address Postal Code:

44195-0001

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

440-878-2500

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

07/24/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207RA0002X , with the licence number:  35-059961 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2080P0202X , with the licence number: 35-059961 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 000000217368 . This is a "UNISON" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 000000526177 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 0647550 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 0791675 . This is a "BCMH" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 200206580A . This is a "OK MEDICAID" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
• Identifier: 0013019200003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 0791675 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
• Identifier: 727590 . This is a "BUCKEYE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 00000027997 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 364162 . This is a "WELLCARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: P00600871 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".