Basic Information
| Provider Information | |||||||||
| NPI: | 1801880471 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DOUMET | ||||||||
| FirstName: | MAHDI | ||||||||
| MiddleName: | NICOLA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4235 SECOR RD | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436234231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194733561 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6855 SPRING VALLEY DR | ||||||||
| Address2: | #120 | ||||||||
| City: | HOLLAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435288039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198653111 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2005 | ||||||||
| LastUpdateDate: | 10/01/2018 | ||||||||
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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 | 207RA0401X | 35.067558 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | Addiction Medicine | 207R00000X | 35067558 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0101348 | 05 | OH | MEDICAID |