Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 35-074409 | OH |
N | 111NI0900X | Internist | 35-074409 | OH |
N | 207RH0000X | Hematologist | 35-074409 | OH |
Y | 207RH0003X | Hematology & Oncology | 35-074409 | OH |
N | 207RX0202X | Medical Oncology | 35-074409 | OH |
NPI | 1427016914 |
---|---|
Provider Name | Malek Mohamad Safa |
First Address | Kettering, OH 45429-1226 |
Second Address | Kettering, OH 45429 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2006 |
Last Update Date | 24/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200344730 | (05) | IN |
2277718 | (05) | OH |
64037724 | (05) | KY |
820000424 | RAIL ROAD MEDICARE (01) | OH |
H45896 | (02) |