Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 079718R | OH |
NPI | 1023125937 |
---|---|
Provider Name | Kamal Sodi Riad |
First Address | Chesterland, OH 44026-3046 |
Second Address | Willoughby, OH 44094 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2006 |
Last Update Date | 26/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H38386 | (02) |