Basic Information
| Provider Information | |||||||||
| NPI: | 1043202187 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KANAYJORN | ||||||||
| FirstName: | ESTHER | ||||||||
| MiddleName: | GRACE PABLO | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 104 ERIN COURT | ||||||||
| Address2: | |||||||||
| City: | HILLSBORO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 451330070 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9373935781 | ||||||||
| FaxNumber: | 9373935784 | ||||||||
| Practice Location | |||||||||
| Address1: | 1092 JEFFERSON ST | ||||||||
| Address2: | |||||||||
| City: | GREENFIELD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 451238319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9379811121 | ||||||||
| FaxNumber: | 9379815660 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2005 | ||||||||
| LastUpdateDate: | 02/19/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 35077853-K | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 363844 | 01 | OH | RHC MEDICARE FACILITY # | OTHER | 2122096001 | 01 | OH | CIGNA | OTHER | 2355053 | 01 | OH | RHC MEDICAID FACILITY # | OTHER | 7724279 | 01 | OH | AETNA | OTHER | 000000184923 | 01 | OH | ANTHEM BC/BS | OTHER | 0401451 | 01 | OH | UNITED HEALTH CARE | OTHER | 2214839 | 05 | OH | MEDICAID |