Basic Information
| Provider Information | |||||||||
| NPI: | 1942209614 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOSH | ||||||||
| FirstName: | SANJIV | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7045 LIGHTHOUSE WAY | ||||||||
| Address2: | |||||||||
| City: | PERRYSBURG | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435517000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198736836 | ||||||||
| FaxNumber: | 4198736837 | ||||||||
| Practice Location | |||||||||
| Address1: | 5300 HARROUN RD | ||||||||
| Address2: | SUITE 304 | ||||||||
| City: | SYLVANIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435602182 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198241100 | ||||||||
| FaxNumber: | 4198241771 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2005 | ||||||||
| LastUpdateDate: | 09/13/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35084406 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 7109632 | 01 | OH | AETNA | OTHER | P00192699 | 01 | OH | RRMC | OTHER | 04581 | 01 | OH | PARAMOUNT | OTHER | 24-46640 | 01 | OH | UHC | OTHER | 000000337806 | 01 | OH | ANTHEM | OTHER | 2499961 | 05 | OH | MEDICAID |