Basic Information
| Provider Information | |||||||||
| NPI: | 1427016914 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SAFA | ||||||||
| FirstName: | MALEK | ||||||||
| MiddleName: | MOHAMAD | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3700 SOUTHERN BLVD STE 401 | ||||||||
| Address2: | |||||||||
| City: | KETTERING | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454291226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8555002873 | ||||||||
| FaxNumber: | 9372813913 | ||||||||
| Practice Location | |||||||||
| Address1: | 3700 SOUTHERN BLVD STE 401 | ||||||||
| Address2: | |||||||||
| City: | KETTERING | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8555002873 | ||||||||
| FaxNumber: | 9372813913 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2006 | ||||||||
| LastUpdateDate: | 11/24/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 35-074409 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RH0000X | 35-074409 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology | 207RX0202X | 35-074409 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology | 207RH0003X | 35-074409 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 200344730 | 05 | IN | MEDICAID | 2277718 | 05 | OH | MEDICAID | 820000424 | 01 | OH | RAIL ROAD MEDICARE | OTHER | 64037724 | 05 | KY | MEDICAID |