Provider Demographics
NPI:1710168323
Name:KANSAL, SHERU K (MD)
Entity type:Individual
Prefix:
First Name:SHERU
Middle Name:K
Last Name:KANSAL
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 1:25301 EUCLID AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-2609
Mailing Address - Country:US
Mailing Address - Phone:216-261-6263
Mailing Address - Fax:216-261-4964
Practice Address - Street 1:25301 EUCLID AVE STE 201
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44117-2609
Practice Address - Country:US
Practice Address - Phone:216-261-6263
Practice Address - Fax:216-261-4964
Is Sole Proprietor?:No
Enumeration Date:2007-11-26
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD432432207R00000X, 208M00000X
OH35.094825207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3075130Medicaid
PA1020598600001Medicaid