Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 57012922 | OH |
Y | 111NI0900X | Internist | 57012922 | OH |
NPI | 1003004128 |
---|---|
Provider Name | Amir Razavi |
First Address | Cleveland, OH 44114-3241 |
Second Address | Cleveland, OH 44109-1900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/10/2007 |
Last Update Date | 15/10/2007 |