Basic Information
Provider Information
NPI: 1487750253
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MIKHAIL
FirstName: YASSER
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 92938
Address2:  
City: CLEVELAND
State: OH
PostalCode: 441942938
CountryCode: US
TelephoneNumber: 4404664641
FaxNumber: 4404661871
Practice Location
Address1: 254 S BROADWAY
Address2:  
City: GENEVA
State: OH
PostalCode: 440411807
CountryCode: US
TelephoneNumber: 2163830100
FaxNumber: 2163836481
Other Information
ProviderEnumerationDate: 09/16/2006
LastUpdateDate: 01/14/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/13/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X35074576MOHY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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