Provider Demographics
NPI:1538269907
Name:RAVEENDRAN, PANICKER (MD)
Entity type:Individual
Prefix:DR
First Name:PANICKER
Middle Name:
Last Name:RAVEENDRAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RAVEENDRAN
Other - Middle Name:
Other - Last Name:PANICKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1001 LAKESIDE AVE E
Mailing Address - Street 2:#1200
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44114-1158
Mailing Address - Country:US
Mailing Address - Phone:216-621-5600
Mailing Address - Fax:216-479-5554
Practice Address - Street 1:12301 SNOW ROAD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44130
Practice Address - Country:US
Practice Address - Phone:216-621-5600
Practice Address - Fax:216-479-5554
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-043447207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E97745Medicare UPIN
RA0700141Medicare ID - Type Unspecified