1265417117 NPI number — MOHAMAD MAROUF MD

Table of content: MOHAMAD MAROUF MD (NPI 1265417117)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265417117 NPI number — MOHAMAD MAROUF MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAROUF
Provider First Name:
MOHAMAD
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265417117
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/05/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24701 EUCLID AVE
Provider Second Line Business Mailing Address:
3RD FLOOR
Provider Business Mailing Address City Name:
EUCLID
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44117-1714
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27100 CHARDON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHMOND HEIGHTS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44143-1116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-585-6500
Provider Business Practice Location Address Fax Number:
330-656-5901
Provider Enumeration Date:
12/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  35075251M , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2225167 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7858192 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 415007 . This is a "WELLCARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: P00432291 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: BUCKEYE . This is a "732690" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000538199 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000381220 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 1265417117 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000221291 . This is a "UNISON" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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