| Doctor Name: | DR. BASAVARAJAPPA VISWANATH |
| NPI Number: | 1144207143 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 35-044261 |
| Business Practice Address: | 125 E Broad St Suite #209 Elyria, OH - 440356400 |
| Business Phone Number: | 4403297320 |
| Business Fax Number: | 4403297319 |
| Mailing Address: | 24701 Euclid Ave, Third Floor Billing Services EUCLID |
| State: | OH |
| Postal Code: | 441171714 |
| Phone Number: | 4403297320 |
| Fax Number: | 4403297319 |
| NPI Enumeration Date: | 12/30/2005 |
| NPI Last Update Date: | 05/14/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 35-044261 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | OH |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |